General Urologist
Having a general urologist perform a vasectomy reversal is a better choice than a non-urologist, in that at least you can typically be assured of a fairly safe procedure. Board-certified urologists have had 4 to 5 years of training in urologic surgeries, and can handle any complications which might arise. However, most training programs for general urology have mininal exposure to microscopic procedures such as vasectomy reversals. General urologists are typically quite skilled at treating kidney stones, testicular cancer, and enlarged prostates, but do not learn the lastest microsurgical fertility procedures. General urologists (and almost all non-urologists) are also typically not able to perform the even more demanding vas-to-epididymis connection if needed (see 'How A Vasectomy is Reversed' Section for more information as to why this is very important).
Fellow-trained Microsurgical Specialist
These urologists have not only completed 4-5 years of urologic surgery training, but have also chosen to devote an extra 1 to 2 years of fellowship training to learn and master the most advanced microsurgical vasectomy reversal techniques. Less then 1% of urologists choose to pursue fellowship training to become true experts in male infertility microsurgery.
Virtually all microsurgical specialists have the following characteristics in common:
a. They use an operating microscope.
Operating microscopes are necessary to allow superior visualization of the operating field for precision surgery. General urologists and non-urologists sometimes use loupes (pronounced ‘loops’) which are less powerful magnifying devices worn on the head. Loupes do not allow as high a degree of magnification, and therefore the tiny vasal structures are less well visualized during the procedure.
b. They take at least 2.5 to 3 hours of actual operating time.
Microsurgical specialists take this long to perform their vasectomy reversals because they know that meticulous surgical technique is necessary for optimal reversal outcomes. The latest, most effective microsurgical techniques take at minimum 2.5 to 3 hours to perform correctly and with proper attention to detail. Reversal procedures that take 2 hours or less of actual operating time should certainly raise suspicion that either the latest microsurgical techniques are not being used, or that attention to detail is less than optimal.
c. They use 10-0 or 9-0 suture.
In surgery, the higher the number, the smaller the suture (i.e. 10-0 suture is much thinner than 8-0 suture). The vas deferens is a very small, delicate structure, and precise surgery requires the use of very fine suture. Almost all microsurgical specialists use size 10-0 and/or 9-0 suture. If a urologist uses larger suture (no finer than 9-0) then he or she may not be using modern updated microsurgical techniques.
Finding a True Microsurgical Specialist
Sometimes this task can be confusing, as most general urologists who offer vasectomy reversals will claim to be 'experts' in microsurgery, despite their lack of training in the latest, most effective reversal procedures. Some will claim to be experts because they have taken short post-graduate courses on the topic. These 1-2 week courses are designed to provide brief updates on male infertility and microsurgery. However, it is impossible to squeeze 1 to 2 years of intensive fellowship microsurgical training into a 1-2 week course. Other urologists claim to be microsurgical specialists because they have been in practice many years and have performed hundreds or thousands of procedures. However, just because a urologist has been treating patients for many years does not mean that he or she necessarily offers the most successful, updated, modern microsurgical techniques. Performing an outdated technique hundreds or thousands of times does not make that technique any less outdated.
Be sure to specifically ask your urologist if they are fellowship-trained in microsurgery- if they are, then you have found a true microsurgical specialist.
