Post Vasectomy Pain Forum

Complications in a Series of 1224 Vasectomies

Complications in a Series of 1224 Vasectomies

Journal of Family Practice, 1991
Philip M. Alderman, M D

The records of 1224 men who had a vasectomy performed by the same technique during a 4-year period were reviewed, and documented complications were tabulated and evaluated. …

Twelve categories of potential complications were defined, o f which 10 were actually encountered in the study group. Infection was defined as having had antimicrobial drugs prescribed, and regret as having returned to discuss a reversal;

Complications had been documented in 124 cases (10.6% ) and included 46 minor infections (3.8% ), 2 serious infections (0.16% ), 23 instances of epididymitis (1.9% ), 16 cases o f sperm granuloma (1.3% ), and 4 minor hemorrhages (0.33% ). …

Given the popularity of the operation, complications are bound to be appreciable. These complications are not necessarily observed by the surgeon, for adverse events can occur months or even years after a vasectomy is performed.

In the 4 years ending December 31, 1989, the author performed 1224 vasectomies, nearly all of which were done in an office setting. Complications continued to be recorded for another year, until December 31, 1990, which provided an additional period for observing possible adverse events.

The mean age of men in the series was 37 .7 years (range 20.8 to 66.4 years);

Where applicable, complications were arbitrarily termed “minor” if the patient required 3 days or less off from work because of the problem, and “major” if more time was required.

1 Epididymitis. Unlike the massive swelling of bacterial epididymitis or the localized nodular tumors of epididymal granulomas, vasectomy-related epididymitis was characterized by a modest inflammation of the epididymis that involved all or most of that structure and principally that structure.

7 Orchitis was diagnosed when postvasectomy inflammation was confined to the testes.

8 Regret for the purposes of this study was classified as a complication of vasectomy and was defined as returning to discuss a reversal.

9 Sperm granulomas occurred as persistent, hard, well-defined nodules that were only slightly or moderately tender or painful. They were found either at a vasectomy site or in the epididymis, and their median time of onset (about 100 days) was sometimes helpful in diagnosis.

Five men had more than one problem: thus, while there were 124 patients who experienced complications, the total number of complications was 130.

Epididymitis

The onset of epididymitis varied widely: of 23 instances 8 reportedly began with the operation, and one did not present until more than 2 years later. In one instance the epididymitis became chronic, and removal of the organ or vasovasostomy was suggested, but to date the patient has declined this procedure. In no instance was there any suggestion that bacterial infection was involved.

Miscellaneous

One case of postvasectomy ejaculatory dysfunction was reported by a 66-year-old patient who was attempting nightly orgasms…

The remaining 12 miscellaneous problems involved intrascrotal pain with scrotal contents that were objectively normal.

Sperm Granuloma

The median time of onset of sperm granuloma was 101 days (range: 19 to 464 days). In this series the size ranged from a few millimeters to 2 cm. Only 4 of the 16 men with granulomas required treatment. In these, anti-inflammatory drugs were remarkably effective in reducing pain.

The incidence of regret, at least as expressed by an interest in discussing a reversal, was 0.82%

Discussion

Given the mobility of populations, the determination of the incidence of events such as granulomas and epididymitis that occur after 5 years is probably unachievable, and for similar reasons is probably somewhat understated in this study. Vasectomy reversal may be undertaken years after the vasectomy and may be done without the surgeon who performed the vasectomy ever being notified.

In reviewing the medical literature, Population Reports, a publication of Johns Hopkins University, indicated that epididymitis occurs in “less than 1% o f vasectomies.”3 In the series reported here, however, it was nearly twice that (1.8% ) and was, after infection, the most common problem seen. Possibly these lesions occurred because sperm production exceeded absorption.

Paradoxically, in all but two cases the epididymitis occurred unilaterally, and it was not evident why only one side was affected. “Congestive epididymitis,” perhaps an aptly descriptive term, has been used to describe this condition. Only 2 of the 23 patients with epididymitis were given antimicrobial drugs, and all resolved satisfactorily, suggesting that infection was not a significant factor for most.

Among the “miscellaneous” group were 12 men with scrotal pain but objectively normal scrotal contents. Only one of these was offered medication; he improved quickly on indomethacin. It was postulated that nonpalpable granulomas, nerve entrapments, or low pain thresholds might explain some of these problems.

Adverse psychosexual problems, while not seen in this series, have on rare occasions been encountered by the author in the past. Although nevertheless desirable, preoperative screening interviews have not been found to be reliable predictors of this event, the treatment of which can be unsatisfactory, to say the least.

Often implicit in the decision to undertake the risks and discomfort of a vasectomy is the patient’s recognition that his wife has been primarily responsible for contraception in the past, that she has borne the burdens of pregnancy and parturition, and that their relationship is a partnership with equivalent responsibilities. Indeed, husbands commonly and gratuitously acknowledge that “it’s my turn.” Among vasectomy accepters, at least, it is also widely believed that male sterilization is simpler and safer than its female counterpart. This view is corroborated in a 1985 study by Smith et al,18 which concluded that “male sterilization procedures were found to have zero attributable deaths and significantly less major complications when compared to female sterilization procedures. No less than 14 deaths per year can be attributed to female sterilization procedures in the United States.”

Conclusions

With the fairly broad definitions of adverse effects used in this study of a series o f excision-ligature vasectomies, the overall incidence of vasectomy complications exceeded 10%. Few were major, however, and the two potential hazards that can result in lengthy disability (major hemorrhages and serious infections) were thought to have been minimized by the liberal use of blunt dissection and antimicrobial drugs.

https://mdedge-files-live.s3.us-east-2.amazonaws.com/files/s3fs-public/jfp-archived-issues/1991-volume_32-33/JFP_1991-12_v33_i6_complications-in-a-series-of-1224-vasect.pdf

Comments:

1000 comp

Complications had been documented in 124 cases (10.6% ) and included 46 minor infections (3.8% ), 2 serious infections (0.16% ), 23 instances of epididymitis (1.9% ), 16 cases o f sperm granuloma (1.3% ), and 4 minor hemorrhages (0.33% ). …

I see that scrotal pain doesn’t get it’s own category. It is listed under Misc, which does not show up in this list in the intro.

These complications are not necessarily observed by the surgeon, for adverse events can occur months or even years after a vasectomy is performed.

None of my patients have ever…

In the 4 years ending December 31, 1989, the author performed 1224 vasectomies

In science, it isn’t a best practice for the person doing the observations to be so tied up with the phenomenon being observed.

Regret for the purposes of this study was classified as a complication of vasectomy and was defined as returning to discuss a reversal.

An objective measure, but way too restrictive of a definition. Especially when men are not told that reversal could help resolve their problems, and considering that insurance won’t pay for a reversal.

Sperm granulomas median time of onset (about 100 days)

Interesting

Given the mobility of populations, the determination of the incidence of events such as granulomas and epididymitis that occur after 5 years is probably unachievable, and for similar reasons is probably somewhat understated in this study.

Author himself recognizes that this is a low-ball estimate

The onset of epididymitis varied widely: of 23 instances 8 reportedly began with the operation, and one did not present until more than 2 years later. In one instance the epididymitis became chronic, and removal of the organ or vasovasostomy was suggested, but to date the patient has declined this procedure.

I guess he doesn’t “regret” the procedure then.

Only 1 of the instances did the epididymitis become chronic. How does the author know this? PVP tends to wax and wane. If it goes away, how do you know it won’t come back if you are not following guys around over long periods?

One case of postvasectomy ejaculatory dysfunction was reported by a 66-year-old patient who was attempting nightly orgasms…

Do I detect a little wry humor here?

The remaining 12 miscellaneous problems involved intrascrotal pain with scrotal contents that were objectively normal.

Here’s our PVPS, tucked away under “misc”. These guys have “objectively normal” scrotal contents yet… intrascrotal pain.

In reviewing the medical literature, Population Reports, a publication of Johns Hopkins University, indicated that epididymitis occurs in “less than 1% o f vasectomies.”3 In the series reported here, however, it was nearly twice that (1.8% ) and was, after infection, the most common problem seen.

So you’re telling me that the Johns Hopkins were lower than what you observed, eh? And this doesn’t include the 12 “objectively normal” men who are nonetheless in pain.

Only 2 of the 23 patients with epididymitis were given antimicrobial drugs, and all resolved satisfactorily, suggesting that infection was not a significant factor for most.

Right. Not bacterial. They resolved satisfactorily… but for how long? “Well he quit making appointments so…”

Adverse psychosexual problems, while not seen in this series, have on rare occasions been encountered by the author in the past. Although nevertheless desirable, preoperative screening interviews have not been found to be reliable predictors of this event, the treatment of which can be unsatisfactory, to say the least.

I wonder if this is more of those guys who say they have disappointing orgasms and low libidos? You know, the guys with “psychosexual” problems?

the treatment of which can be unsatisfactory, to say the least.

Doctor has a lot more he could say about how bad this is, but not here LOL.

his wife has been primarily responsible for contraception in the past, that she has borne the burdens of pregnancy and parturition, and that their relationship is a partnership with equivalent responsibilities. Indeed, husbands commonly and gratuitously acknowledge that “it’s my turn.”

Author sees the “it’s my turn” thing as the reality that husbands are gracious to acknowledge.

Where applicable, complications were arbitrarily termed “minor” if the patient required 3 days or less off from work because of the problem, and “major” if more time was required.

the overall incidence of vasectomy complications exceeded 10%. Few were major, however,

Major, defined as requiring at least 4 days off from work because of the problem.

If you can still work, as far as this author is concerned, you do not have a major problem.