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Mr Harris and Mr Holmes (October 2001 JRSM, pp. 510-511) are correct in stating that an unwanted pregnancy following a vasectomy failure due to late recanalization ‘can have devastating social and financial consequences’. But their advice that it is sufficient to warn the patient that the (average) risk of such failure is ‘about 1 in 2000 cases’ is, I believe, flawed in two respects. First, it leaves unanswered what sensible advice can be given to a patient who asks what can be done to reduce this risk. Secondly, the term ‘vasectomy’ includes a range of procedures—from the removal of several centimetres of vas (with wide separation of the ends) through division of the vas and separation of the ends by tissue interposition1 to diathermy of the intact vas resulting in an obstructed segment less than 2 mm in length2. The risk of recanalization when the diathermy technique is used must be far greater than the average quoted, and therefore the advice given will be incorrect (and so any consent improperly obtained).
Because of the rarity of recanalization an individual surgeon cannot calculate the risk for the procedure that will be used. But surely the British Association of Urologists ought by now to have collated the results of a large enough number of surgeons, grouped by the type of ‘procedure called vasectomy’ that they use, for a statistically valid estimate of the risk for each procedure to be made. Patients would thereby be better informed and so able to choose a less risky procedure if they wished, and the profession might be less at risk from litigation2,3.