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Campbell Walsh Urology 11th Edition will revise PVPS risks to 1-2% of patients

I win at the internet.  Sort’ve.

Post-vasectomy pain syndrome has had this “1 in 1000″ patient number floating around for a while, and I’ve never been able to track down where it came from until the last couple of months.   Turns out – that numbers is bunk.

After a series of 35 emails back and forth with Elsevier, the publisher of Campbell Walsh Urology – I can confirm now that the 11th edition will include dramatically higher risks for incurring post-vasectomy pain syndrome.

The 10th edition has this to say on the topic:

Up to 30% of men have short-term scrotal pain lasting a few weeks. However, postvasectomy pain syndrome, or long- term scrotal pain after vasectomy, occurs in approximately one in 1000 vasectomies, although some report the incidence to be as high as 15% (McConaghy et al, 1996; Awsare et al, 2005; Tandon and Sabanegh, 2008).

If you take the time to go through those citations, no such claim is actually made.

McConaghy 1996:

Following a study by McMahon et al. which found that 33% of patients were troubled with chronic testicular discomfort following vasectomy [1], a study was undertaken at our hospital to examine ways of reducing the incidence of this problem. This work has been published recently [2] and we would like to draw your readers’ attention to the relevant findings.

This may result from congestive epididymitis or the development of sperm granuloma. The incidence of chronic orchalgia is quite high (12–52%). [5] The proportion of patients, however, whose quality of life was affected, or those who sought treatment was much lower (2.2–15%)

Tandon 2008 is more complex.  It has this to say:
PVPS is disappointingly common and difficult to treat. Although early pain lasting for a few weeks is fairly common after vasectomy (present in up to 30% of men), longterm pain requiring some kind of intervention or surgical therapy occurs in up to one in 1000 vasectomized men [4].
Tracking down the claim for one in 1000 vasectomized men in citation 4 gives us :
Sandlow JI, Winfield HN, Goldstein M. Surgery of the scrotum and seminal vesicles. In Wein AJ, Kavoussi LR, Novick AC, Partin AW eds, Campbell-Walsh Urology, 9th edn. Philadelphia: WB Saunders, 2006: 1103–9

So what we have is Campbell Walsh citing a paper which cites Campbell Walsh.

There’s never been any evidence that supported the claim of 1 in 1000 number.

So that’s the good news.  That number is going away.

I’m told by the reviewers in Elsevier that they will be using Leslie 2007 for most of their new data and they will also be using the AUA guidelines.

Unfortunately, you won’t be able to verify this until 2016 because Elsevier can’t seem to figure out how to use the internet to publish errata.

Yes – you will need to wait for the dead tree version of the book to come out.

The irony here is a bit thick even for me.

BJU offers open access to Leslie 2007.  After I compiled the trail of papers that made this error possible – I asked to review the draft of the new chapter on vasectomy.  That was October 1.

Here’s the response:  “ would be highly inappropriate to provide a draft chapter prior to the text being published.

Screw you Elsevier.

Cutting and pasting from German is hard

Sometimes people mess up translations.

Maybe it’s the gutteral sounds of German.

Medline incorrectly got the lower bound of chronic pain post vasectomy as 0.5% when it should be 3%.  Here’s the correction I’ve filed with Pubmed and the original full text (in German).

PubMed link:

You can find the data in Table 2.

PMID:  21845426
TITLE: Ischemic testicular necrosis following vasectomy: rare and typical complications of an outpatient procedure
TEXT: Late complications are chronic pain (0.5-18%), pain during sex (2.9%), hydrocele (0-4%) as well as spermatocele (1.6%)
CORRECTION: Late complications are chronic pain (3-18%), pain during sex (2.9-5%), hydrocele (0-4%) as well as spermatocele (1.6%)
NOTE:  The data in question is in Table 2 on the fourth page. I’ve attached the article for your reference.

Original journal article:  Ischemic testicular necrosis following vasectomy: rare and typical complications of an outpatient procedure

Silver linings

So I was going to post more, but life happened.

This is going to be a short one.

Despite PVPS taking up more of my attention than I’d like, lots of other things have been really great this year.

The kids are getting smart. Possibly too smart. 

Rosie is picking up piano at a startling pace. I think the kid has some natural talent there.

I also decided to get some exercise starting in May.  I’ve since shed 4 inches off the waist and gained enough strength to be doing double handed exercises with 45lb kettle bells. 

Parallette work is coming along, I can almost do a proper L-sit, and running 5-7km is pretty easy for me now.  Not too shabby for a former couch potato.

Have a great year everyone!

Testosterone therapy

Managed to dig up a full text copy of the 2007 paper by E.J. Pienkos on testosterone therapy for PVPS patients.

Not much data to see, and like most papers – it’s pretty thin.

Still – it’s better than only getting the abstract from PubMed.

The use of testosterone in the treatment of chronic postvasectomy pain syndrome: case report and review of the literature.