The Effect of Male Age Over 50 Years on Vasectomy Reversal Outcomes.

OBJECTIVE: Advancing paternal age is associated with impaired semen parameters. We sought to evaluate reproductive outcomes in men undergoing vasectomy reversal (VR) aged ≥50 vs <50 years. METHODS: Reproductive outcomes (obstructive interval, female age, anastomosis type, post-VR total motile count (TMC), and pregnancy) after VR were assessed for men aged <50 and ≥50 years. Statistical analysis was performed using Kruskal-Wallis rank sum or Chi-squared tests. Multiple logistic regression was used to identify factors associated with achieving pregnancy. RESULTS: A total of 2777 men <50 years and 353 men ≥50 years were included. The mean obstructive interval was 8.7 years less for men <50 years (8.9 vs 17.6 years, P <.001). The chances of needing a vasoepididymostomy were higher in men ≥50 years (19.5% vs 10.1%, P <.001). Post-VR total motile count was higher in men <50 years (59.3 vs 29.1 × 106/mL, P <.001). About 33.4% of men <50 years and 26.1% ≥50 years contributed to a pregnancy (P = .007). On multiple logistic regression analysis, obstructive interval <10 years (OR 1.295, P = .002) and female age <35 (OR 1.659, P <.001) were associated with achieving a pregnancy. A history of smoking was associated with decreased odds of achieving a pregnancy (OR 0.523, P <.001). Age <50 or ≥50 years at VR was not associated with achieving pregnancy (OR 0.852, P = 0.254). CONCLUSION: Compared to those ≥50 years, more men <50 years achieved a pregnancy after VR. However, on adjusted multivariable analysis, age at VR was not an independent predictor of achieving pregnancy. Shorter obstructive interval and female age were associated with achieving pregnancy, while a history of smoking was associated with decreased odds. Successful outcomes after VR can be achieved in older men, and VR should be considered in men ≥50 years, when performed by a trained microsurgeon.

Angled vas cutter for vasovasostomy: technique and results.

OBJECTIVE: To describe the technique and results of bilateral vasovasostomy using a 3-mm vas cutting forceps angled at 15° (catalog no. NHF-3.15; ASSI) for vasal transection. DESIGN: Retrospective chart review. Institutional review board approval was granted by Western Institutional Review Board. SETTING: Single vasectomy reversal center. PATIENT(S): Men who underwent a bilateral vasovasostomy at a single institution by a single surgeon between 2001 and 2012 and had a minimum of one semen analysis postoperatively or a reported natural conception. INTERVENTION(S): Before September 14, 2010, a straight-edge vas cutter was used on all vasovasostomy connections; 375 men received a bilateral vasovasostomy and met follow-up criteria. Beginning on September 14, 2010, an angled cutter was used on all vasovasostomy patients, with 194 men meeting the exclusion criteria. MAIN OUTCOME MEASURE(S): A minimum of 1 × 10(6) sperm reported on a postoperative semen analysis, or a reported natural conception was used to establish patency. RESULT(S): The overall vasovasostomy patency rate using the angled vas cutter was 99.5% and was 95.7% using the straight vas cutter. CONCLUSION(S): The development of an angled vas cutter provides an increased surface area for vasal wound healing to allow for larger tissue diameter for better healing, resulting in high patency rates after vasovasostomy.

Comprehensive office evaluation in the new millennium.

The success of a comprehensive office-based evaluation of male-factor infertility depends on the physician's thorough understanding of risk assessment in the history, identification of pertinent physical examination findings, and correct assessment of laboratory data. Office-based ultrasonographic techniques have already increased the urologist's ability to visualize suspected anatomic abnormalities, and the use of functional tests of sperm has given greater depth to the limited, but essential, prognostic capabilities of the routine semen analysis.

A Modified Contrasting Groups Method Used for Setting the Passmark in a Small Scale Standardised Patient Examination.

The 'Simulated Surgery' is an alternative consulting skills component of the Membership examination of the Royal College of General Practitioners, which is the professional certifying examination for GP registrars (family medicine residents) in the UK. It consists of a 20 station OSCE and is taken by a small cohort of candidates (10--30) who are unable to provide a videotape of their patient interviews for assessment. The passmark for this examination has been set by a modified contrasting groups method, in which all the examiners make pass/fail judgements on all the candidates' performance by reviewing their whole-test grades. A consistent passmark was obtained for two different cohorts and this method should allow a constant passing standard to be maintained under changing circumstances in the future.