Monthly Archives: February 2013

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: http://www.ncbi.nlm.nih.gov/pubmed/21845426

You can find the data in Table 2.

PMID:  21845426
TITLE: Ischemic testicular necrosis following vasectomy: rare and typical complications of an outpatient procedure
PUBLISHER: Urologe A
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

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CUA finally responds

Well, it took a long time – 4 months to be precise – but the Canadian Urological Association finally responded to me.

Starting back in October 2012, I asked them to review the literature that they provide urologists – who in turn provide information to patients about post-vasectomy pain risks.  I didn’t get a response, but I followed up with several emails, some phone calls.  Not much luck.

I ended up getting in touch with Keith Jarvi – the director of Mount Sinai’s Urology program (Keith was a peer-reviewer for the AUA guidelines).  He kindly contacted the president of the CUA with my concerns and it looks like the guidelines committee at the CUA has finally come to a decision.

But first – some context:

The CUA provides a single pamphlet of information to patients.  The only reference to pain is:

Some men have scrotal pain that persists for a few weeks or months. Over time, this usually resolves completely without specific treatment, although rarely this discomfort may persist.

CUA pamphlet

The American Urological Assocation is pretty different.

The minimum and necessary concepts that should be discussed in a preoperative vasectomy consultation include:

…[some text removed]

Chronic scrotal pain associated with negative impact on quality of life occurs after vasectomy in about 1-2% of men. Few of these men require additional surgery.

AUA Vasectomy Guidelines

Maybe it’s just me, but the CUA makes it sound like the worst case is pretty innocuous.  ‘Discomfort’ is a lot less alarming to read than “negative impact on quality of life’.

So here’s the less than ideal response I got back tonight.

Dear Mr. Ng,

I would like to inform you that your concerns have been raised with the committees that deal with guidelines and pamphlets, and appropriate consideration has been given. The final conclusion was that the information currently provided on the subject of post-vasectomy pain was suitable as written.

Thank you,

Karen Psooy, Secretary CUA

Next week, I’m heading down to Florida for microsurgical denervation.  It’ll be paid out of paid out of pocket – insurance won’t touch it.

I’d consider getting it done in Ontario, except I can’t seem to even get call back from the pain management clinic at the hospital.  I’d even appreciate a “sorry – we’re too backed up here – go somewhere else”, but apparently – that’s too much to ask for.

At this point, I’ve had it – so off to America.

Your healthcare system may suck America, but at least they fucking call you back.

Edit: fixed my borked links to the CUA and AUA guidelines