Survey of Microsurgery Training Availability in US Urology Residency Programs

Abstract

Purpose The Accreditation Council of Graduate Medical Education (ACGME) establishes surgical minimum numbers of cases for urologic training. Currently there is not a requirement for microsurgery, likely from a belief that programs do not offer exposure. In an effort to evaluate the availability of microsurgery training among urology residency programs we surveyed the programs. Materials and Methods We obtained a list of the 138 ACGME-accredited urology residencies and contact information the American Urology Association (AUA). We contacted the residency programs by phone and e-mail. For programs that did not reply, we performed a search of the program website. We answered 3-questions to assess resident subspecialty training in microsurgery and used penile implant and artificial urinary sphincters as a comparison. Data are reported as frequencies. Results We obtained data from 134 programs (97.1%). A total of 104 programs (77.6%) had fellowship-trained physicians for training in microsurgery, 86.6% for penile implants, and 88.8% for artificial urinary sphincters. The percentage of fellowship-trained microsurgeons per program did not vary significantly when comparing the different sections of the AUA. The northeast and southeast sections had the lowest percentage (67% and 68%). Conclusions Nearly 80% of urology residency programs have a fellowship-trained microsurgeon on faculty, we therefore believe that microsurgery should be added as part of the ACGME minimums. In order to provide an equal exposure to all graduating urology residents, urology residency programs that lack microsurgery should identify potential faculty with fellowship training.

Microsurgical Management of Male Infertility: Compelling Evidence That Collaboration with Qualified Male Reproductive Urologists Enhances Assisted Reproductive Technology (ART) Outcomes

“…For some surgeons, overcoming this learning curve may be a challenge due to their limited exposure to microsurgical cases during residency training. In a recent survey of the Accreditation Council of Graduate Medical Education (ACGME) urology residency programs, 22.4% of programs did not have a fellowship-trained microsurgeon on the faculty [ 149 ]. While this survey was unable to assess the microsurgical case volume of these trainees, this finding suggests that approximately one in five United States urology residents may not have exposure to microsurgical training during their residency.…”

Vasectomy reversal vs. sperm retrieval with in vitro fertilization: a contemporary, comparative analysis

“…It must be noted that all considerations for costeffectiveness in the preceding studies assumed that the female partners were ovulating and overall had no significant health consideration that would compromise fertility-the sole cause of the couple's infertility was secondary to the after vasectomy male partner. Although VR is a more cost-effective option, other factors such as female factor infertility, advanced maternal age, and lack of access to microsurgicaltrained urologists to perform a VR may prevent VR from being a realistic option for fertility, and IVF may then be the only option (42). In situations in which couples opt for VR to be performed by a surgeon outside of their local region, athome semen analysis kits are a cost-effective, rapid option for follow up assessment of VR success (43).…”

“…Access to a skilled microsurgeon is an important consideration for VR. Although approximately 77% of urology residency programs had fellowship-trained physicians practicing microsurgery, there still remains a group of practices and areas in the country that lack access to appropriately trained microsurgeons (42). In this scenario, VR may not be an option.…”

Technological Advancements in Male Infertility Microsurgery

“…Male infertility microsurgical procedures comprise some of the most technically challenging surgical operations, and thus, appropriate training under the operating microscope is imperative to optimal outcomes [ 30 , 31 ]. Currently, the majority (approximately 80%) of Accreditation Council for Graduate Medical Education accredited residencies have a fellowship-trained microsurgeon on faculty, allowing young urological surgeons early exposure to microsurgery [ 32 ]. However, performing a procedure only several times may not provide the expertise that one needs to be successful with male infertility microsurgical procedures.…”