Article révisé par les pairs
Résumé : Introduction & Objectives: After vasectomy, 5% of men will request a reversal surgery. We have conducted a 3-step observational clinicalstudy to develop a vasectomy regret risk score.Materials & Methods: Focus group of experts (FG): Interview of experts involved in male health who proposed regret risk factors forvasectomy. Clinical study: Pre-specified factors were studied in a Belgian population who had undergone vasectomy in the last 15 years.International Delphi consensus: Embedding vasectomy regret risk score in the light of the clinical study presented to the experts.Results: 17 risk factors for vasectomy regret were identified by 52 international experts in the FG. Out of 1200 patients, 594 (49.5%)responded to the study. Five criteria were found significant: young age (<35 years old), impulsive patient, low education level, patient whodidn't understand the irreversible character of vasectomy, ideally using female contraception or no. On multivariate analysis, three risk factorsused to build the decision algorithm considering the irreversible character of the procedure and the absence of child's wish in the future as a“sine qua non conditio”. Exclusion of the educational level. Elaboration of a decision algorithm to target patient needing information on spermcryopreservation before vasectomy with the 3 factors (risk score ≥4) or extra delay reflection (risk score ≥7). The scoring system was proposed to 52 international experts and was accepted after two rounds of discussion, with 86.7% of experts strongly agreeing and 6.7% weakly agreeing Sensitivity and specificity of the model was 0.98 and 0.53 respectively.Conclusions:We establish a decisional algorithm with 3 factors and 2 sine qua non condition to target patient needing information on spermcryopreservation before vasectomy or extra delay of reflection in order to decrease the risk of vasectomy regret and the spermcryopreservation rate.

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