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The report by Mr Khan and Mr Novell (November 2001 JRSM1) raises the important issue of proper clinical examination, no matter how minor surgery is going to be. I had a similar case which was placed on my waiting list without proper examination of the scrotum. One could imagine the distress to both the patient and the surgeon when the procedure is performed under local anaesthesia. As they say, the scrotum should be examined prior to vasectomy. If there is any doubt about the presence of the vas deferens, ultrasound of the scrotum and the kidney should be done.