If the latest most successful reversal techniques take 2.5-3 hours under general or spinal anesthesia to perform, why are these not universally used by surgeons? The primary reasons are simple: medical training and marketing.
In terms of training, if a doctor has not undergone microsurgical fellowship training, then they probably do not know how to perform the longer most advanced reversal techniques. Older less successful reversal techniques are easier to perform and take less time (typically 1.5 hours). In a nice example of turning lemons into lemonade, low cost reversal doctors can use the short operative times associated with these outdated techniques to offer quick reversals at very low prices. All that is needed is a nice website that states that their success rates are equal to (or even better than) those of fellowship-trained experts, and you have a marketing coup: the "same" product for half the price.
Could a fellowship-trained expert offer very low ($3000 or less) prices for a reversal using the latest techniques? This would be virtually impossible to do, as to decrease the price, shortcuts would have to be taken. This would include cutting out the fee of the surgery center and performing the procedure in their office. If the procedure is performed in the office, then general anesthesia cannot be used. If local anesthesia needs to be used, then the procedure has to be relatively short (typically around 1.5 hours). If you have to cram 2.5-3 hours of surgery into 1.5 hours, then the precision and steps of the latest most successful procedures almost invariably cannot be used.
So what kind of doctors are taking these short-cuts for marketing purposes? I am glad to say that, to my knowledge, none of my Urology colleagues who have undertaken fellowship-training in microsurgery have sacrificed their standards of surgical care by offering these types of low-cost reversals. It is very interesting that the vast majority of these low-cost reversal surgeons are not even urologists at all. A review of their websites show that they are orthopedic surgeons, thoracic surgeons, general surgeons, even internal medicine doctors. None of these non-urologists have had the 5-6 years of urologic residency training to ensure basic safe surgical techniques of scrotal surgery. If you are not a urologist, you cannot even apply for the 1-2 years of microsurgical fellowship training in male infertility, as non-urologists are not felt to have learned the basic body of knowledge and skills for safe scrotal microsurgery.
Another reason that these non-urologists are more likely to offer ‘low-cost’ reversals is that they probably could not offer reversal procedures under general/spinal anesthesia at most surgery centers even if they wanted to. Almost all accredited surgery centers and hospitals have strict credentialing policies which carefully scrutinize a surgeon's training to make sure that they have undertaken the basic training in the surgical field for which they want to perform procedures at that facility. For example, if a surgeon wants to perform orthopedic procedures at a surgery center, they have to first provide documentation that they have successfully completed a formal orthopedic residency training program and are board-eligible or board certified by the national orthopedic credentialing organization. In this way, patients know that if they choose to have a procedure at a certain facility, they have a level of comfort in knowing that the surgeons who work there have at least had basic training in that particular field. Therefore, it would be difficult if not impossible for a urologist to get priveleges to repair fractured bones at most any surgery center in the United States, and likewise these same surgery centers would not allow an orthopedic surgeon to perform genital duct urologic surgery within their facility.
Unfortunately, no such regulations for patient protection exist when practicing medicine in your own private office. If a procedure can be performed under local anesthesia and a doctor has a valid medical license in any field of practice, that doctor can go ahead and offer that procedure in their office without any oversight. Therefore, as a patient, you need to be extra careful in checking the credentials of surgeons who offer procedures in their private office, as their credentials and training background have not been ‘pre-screened’ by a surgery center or hospital.
