Urology

Nov. 19, 2021

Each year, 500,000 men pursue vasectomy in the United States. Of these patients, approximately 6% ultimately pursue a vasectomy reversal. This choice can be made for various reasons, such as a second marriage or the devastating death of a child.

Compared with vasectomy, which is a quick, technically straightforward procedure that can be performed by most urologists, vasectomy reversal is an extremely complex surgery. The surgery can last anywhere from 3 to 5 hours and may best be performed by a fellowship-trained urologist who is skilled in the use of operating microscopes. Additionally, vasectomy reversal is almost never covered by insurance, requiring patients to pay thousands of dollars out of pocket.

Given both the complexity and cost of vasectomy reversal, it is important for patients to be able to compare various vasectomy reversal providers around the country. Ideally, finding out basic information such as a provider's qualifications, surgical volume and cost can be done from the convenience of one's own home through internet searches, instead of having to travel and pay for consultations with each provider.

For a study published in Urology in 2021, Masaya Jimbo, M.D., Ph.D., a Urology resident at Mayo Clinic in Rochester, Minnesota, and colleagues performed Google searches for vasectomy reversal practices in the 50 most populous metropolitan areas in the United States and then reviewed those practices' websites.

The researchers developed a novel scoring system that they termed REVERSAL. The system evaluates risks, education, vasoepididymostomy, expense, rates of success, surgical volume, alternatives and level of education. The REVERSAL score grades each practice on the following:

• The amount of basic information provided on the website such as cost, surgical volume, and risks of and alternatives to vasectomy reversal
• Provider qualifications such as residency and fellowship training and whether providers can perform a vasoepididymostomy, an advanced type of reversal that is required in up to 26% of cases

Unfortunately, most practices fared poorly: 61.7% of practices received a REVERSAL score of six or less, of a maximum 12. "This finding means that many practices had issues with not disclosing basic information such as surgical volume and cost; or providers not being fellowship trained or not even being urologists in the first place, or not being able to perform vasoepididymostomy — or both," says Dr. Jimbo.

Of 107 total practices, only 35 disclosed the costs of vasectomy reversal on their websites. The average cost of vasectomy reversal was $5,990. "Importantly, non-urologists charged significantly less than urologists — $3,584 versus $6,591," says Dr. Jimbo. "Also, even among urologists, those who were not fellowship trained in vasectomy reversals charged significantly less than fellowship-trained urologists — $5,405 versus $6,769."

"The ideal vasectomy reversal provider is a fellowship-trained urologist who specializes in microsurgery, does the procedure regularly and has consistent results," says Sevann Helo, M.D., a urologist at Mayo Clinic in Minnesota, and senior author of the study. "Consider the amount of research you do before buying a laptop or a car. Why wouldn't you invest as much, if not more, time into doing your due diligence prior to undergoing surgery?

"Patients should feel empowered to ask their surgeon, 'How many of these surgeries do you do a year and what are your success rates?' Our study shows that it is hard to obtain that information from most provider websites. Unless we increase the availability of information for patients, they may be lured by aggressive marketing and rock bottom prices."

For more information

Jimbo M, et al. Vasectomy reversal online marketing practices: What are we putting out there? Urology. In press.