Published in “Postgraduate Medical Journal”
Review of the complications and medicolegal implications of vasectomy
problems relating to vasectomy are the main cause of claims against GPs for medical negligence related to minor surgery.
Litigation against secondary care practitioners, mainly urologists and general surgeons undertaking vasectomy in the hospital setting or in private practice, is also highly prevalent.
The problem of chronic testicular pain after vasectomy has become increasingly recognised and is common enough to mention during counselling. It is certainly the subject of litigation and a difficult clinical problem to investigate and treat. Painful and clinically tender post-vasectomy nodules can be excised and epididymectomy to include the lower vas segment may be successful if the pain persists. Orchidectomy should only be a very last resort. If this course is pursued the patient may well then present with pain in the other testicle.
Choe and Kirkemo found post-vasectomy scrotal pain to be the commonest late complication in 34 out of 182 patients (18.7%), which adversely affected the quality of life in four (2.2%). Thirteen men (9.3%) were dissatisfied with the decision to undergo vasectomy and 10 of these listed chronic scrotal pain as the reason. McMahonet al are clear in their advice regarding chronic testicular pain: “Those performing a vasectomy are under an obligation to ensure that patients requesting the operation are aware of the risk, albeit with the reassurance that in the majority of cases the pain is comparatively mild and only rarely requires further medical or surgical intervention”.
We agree that the evidence is such that men should be warned about the small possibility of chronic testicular pain after vasectomy and that this is sometimes difficult to treat successfully. Referral to a pain clinic for management may be necessary when it occurs.
Why are doctors sued post-vasectomy?
Doctors are sued after vasectomy for several reasons:
- Failure of the operation to render a man sterile resulting in an unwanted pregnancy.
- Significant postoperative haematoma formation +/- infection requiring operative intervention.
- Chronic scrotal pain sometimes requiring further surgery which is not always successful.
- Atrophy or loss of a testicle following 2 and sometimes 3.
- Failure to inform the patient of a positive postoperative semen sample.
For the majority of men, with a low risk of complications, vasectomy is an acceptable and effective method of permanent contraception. For the unfortunate few, however, in whom the operation fails to render them sterile or who have significant postoperative complications, litigation is an increasingly popular method of obtaining compensation and causing considerable distress to the unfortunate doctor concerned. Much of this distress is avoidable by good communication, accurate and comprehensive note keeping, and a sound surgical technique.
Note the “distress” in the last sentence refers to the distress the doctor experiences when they are sued by the patient who was not adequately warned and had a bad outcome.