What in the world is going on with PVP?
Nick
which generated a lot of interest. However, I continue to read these
messages almost daily. Now, I would agree and understand that the
VAST majority of men never have problems, and therefore, will not be
visiting this site now or in the future. So with that in mind, it
seems natural that the men who are experiencing problems will be more
frequent visitors to this site than those who are not having problems.
Hence there are a lot of reports of PVPS. But even with a skewed
number of men with problems visiting this website (assuming that is
true), I don't understand if this is happening, WHY ISN'T THIS MAKING
NEWS? A small blip on the consent form indicating a potential of pvp
isn't what I consider sufficient to inform men and the general public
of the risks. And I am sure there are just as many risks with tubals
as well. But, there are men responding to this newsgroup who are
unable to even work due to a vasectomy. My wife would like for me to
get a vasectomy, but when I tell her the "potential" problems, she
looks at me like I have lost my mind. Her OBGYN says there is nothing
wrong with vasectomies and your husband is just protecting his balls
because he is afraid for someone to operate on them. I have great sex
using a condom and although it would be greater if I didn't, is it
worth the risk? I also have a left side varicocele, and this could be
a potential problem as well.
Sorry, but I just had to say this.
Nick
Giraud
vasectomy, and all of these reports freak me out a little too. It doesn't
make sense that so many men are experiencing PVP and yet it's only reported
on newsgroups. The web sites, like dontfixit.org, are blatently
sensationalistic, and it's hard to distinguish honest sites and accounts
from those with perhaps a religious anti-vasectomy agenda.
Something definitely is amis here. It's hard to put my finger on, but it
doesn't all pan out. Either vasectomy's PVP risk is greater than the
public realizes, and it's been carefully hidden, or there is a lot of
propaganda that disguised as PVP reports.
It's all a bit confusing, so I share your feelings on this. I too would
like to know the truth, but we may never know for sure what is hype and
what is reality.
I have experienced what some others here have: some discomfort and/or
"pressure," but my vasectomy is only 6 months old, and it seems that many
men here report that the time of adjustment can be at least this long.
Giraud
David
> doesn't all pan out. Either vasectomy's PVP risk is greater than the
> public realizes, and it's been carefully hidden, or there is a lot of
> propaganda that disguised as PVP reports.
>
> It's all a bit confusing, so I share your feelings on this. I too would
> like to know the truth, but we may never know for sure what is hype and
> what is reality.
Part of the problem is how pvp is categorised by patients and doctors, and
part of the problem is that whilst vasectomy may cause certain conditions in
some patients such as epididymitis, it's also an extremely common GU problem
that happens to a great many men anyway. Also, it's clear that men don't
always discuss their medical history and any concerns/aches pains during the
consultation.
What is attributable to vasectomy and what isn't it clearly isn't that easy
for anyone to ascertain, and as you quite rightly say the hype and hysteria
doesn't exactly help anyone.
I'd go with the big picture on this - if the problem was really as big as
some think, then yes there would have been a lot of publicity about the
issue. People aren't shy of standing on soap boxes and are also litigation
hungry, and I don't believe there is a conspiracy to bury bad news either -
how would that work on a worlwide scale?
Steve Law
All of the posts in this thread are well thought out; yours, Girauds &
Davids. I take a slightly different take on it. I did not report my
PVP to a doctor until my testosterone dropped. I did a lot of reading
(before the Web), so did not even lurk.
What surprised me was when I decided to ask some friends who had had a
vasectomy if they had similar experiences I was met with acclaims of
"I thought I was the only one" since they had heard of no problems.
Part of the problem is men themselves rarely admit to these problems.
It may be that any problems in that area will seem like they have lost
some virility. Seeing men do comb overs and other such non-sense it
easy to see where a man may want to ignore anything that will seem to
make him less manly.
One very close friend who actually said the vasectomy was OK when I
asked him about it before mine, when I told him of the PVP type pain I
was experiencing said he had that too but thought he was unique or it
might not be part of the vasectomy.
So the issue is complex, with no real studies being done to identify
the true risk factors. There are lots of examples of the medical
establishment having too much faith in their own procedures or
protocols. It took congressional legislation to allocate money for the
women's HRT study that was free of biases of sponsors (like
Schwingle). Lately the news reports that Bayer was aware of the
dangers of Baycol before they put it on the market, but went ahead
anyway and did report their internal findings to the FDA while going
through the process to have it approved is an example that you must
err on the side of safety when it comes to your own health.
If you have lurked here for anytime at all you will see references to
studies that show damage to the endocrine system of men who undergo
vasectomy, yet rather than acknowledge this risk, folks will go to
lengths to rationalize away these studies. Same with Prostate cancer.
Same with PVP (the silliest - your PVP is due to regret because your
wife forced you to have a vas).
As to litigation. It is harder than you think. Every Urologists or
surgeon just points to the AMA and says I followed 'the standard duty
of care' for this procedure. It takes pretty deep pockets to go
against the AMA and Insurance companies who would have a lot to loose
once the first case of vasectomy tort was won. Look to the 40-50 years
of cigarette litigation and the clearer link established between
smoking and disease as an example.
This is why I still post here and take the flames as a result, so that
men who question the rationale know they are not alone in wondering
what makes sense.
Just ask yourself, does common sense say you should cut a healthy part
of the body. Especially a part that is so vital to male health - yes
vital is esteem also, but with the studies on endocrine damage,
prostate cancer elevated risk, PVP, and those that will suffer from
effects of ASA, does it make sense for you.
To quote Dirty Harry (Clint Eastwood), "Do feel lucky punk, well do
you?"
Steve L
"Been There, Done That, Still Paying The Price"
Rick
policy issues but have never done so about my PVP because it is a
personal matter and embarassing. I would not be suprised if 99%
of people would choose not to publically talk about pain, soreness,
swelling, discoloration, etc. in their sexual organs. To most
people, I think, this would be very personal.
Rick
(Just saw a great movie! , The Four Feathers)
trifold
These are interesting points, and David, as always, has replied very
sensibly.
I agree with you that if pvp--as in persistent, troublesome pain for
more than 3 months--were common, it would be more in the news. One
reason we hear of it here is that this site is designed to help men
with problems. Another is that sometimes we hear from men in the
first three months before the occasional discomfort some experience
goes away. Another is that scrotal pain develops in lots of men
overtime, whether they are vasectomised or not. But guys who have
been vasectomised quite naturally suspect the vasectomy might be at
fault. When I was considering vasectomy I looked at the stats.
showing chronic pain/discomfort more than 3 months after. I saw that
very few men reported this. Of those, most said it was so mild it
didn't bother them. I also looked at the success rates of therapies,
and saw they were very good. Then I considered my personal situation.
I knew continuing on the pill was dangerous for my wife (her doctors
told her so). She was proposing getting a tubal, but my research
showed me that the risks of a tubal are far greater than those of
vasectomy (also recovery time is greater). And I knew I didn't want
to go back to using rubbers or some other less reliable, more
inconvenient, less sexy kind of birth control. Most of all, I knew we
didn't want children--and that being sterile would not affect my
pleasure in sex or the way I thought about myself. So I decided for
vasectomy. It is a personal decision not to be taken lightly. But I
am committed enough to it as an option for men and their partners--and
committed enough to the rational process--that I think it is important
to address claims of risk here that are exaggerated and sometimes even
irresponsible.
trifold
http://www.vasectomy-information.com
trifolddecided it was worth the risk. (And
<45e78dc3.03031...@posting.google.com>...
trifold
> Just ask yourself, does common sense say you should cut a healthy part
> of the body. Especially a part that is so vital to male health - yes
> vital is esteem also, but with the studies on endocrine damage,
> prostate cancer elevated risk, PVP, and those that will suffer from
> effects of ASA, does it make sense for you.
I'm glad to see you admit that some men are affected by "esteem"
problems after vasectomy and that this may contribute to their
complaints. As for your other insinuations, that there is convincing
medical evidence of endocrine damage, elevated prostate cancer risks,
adverse effects of ASA, and high risk of persistent UNTREATABLE
chronic scrotal pain, all I can say is: "Show me."
Vasectomy is not for everyone. There are good reasons not to do it.
Being very very nervous might be one good reason. But no one really
needs a reason not to do it (at least not here). But we will not
tolerate those who try to scare people away by drawing on outdated
research and unfounded assertions. (PS: This is not a flame.)
trifold
http://www.vasectomy-information.com
trifold
r -
> Hello David -- I have taken public stands many times on public
> policy issues but have never done so about my PVP because it is a
> personal matter and embarassing. I would not be suprised if 99%
> of people would choose not to publically talk about pain, soreness,
> swelling, discoloration, etc. in their sexual organs. To most
> people, I think, this would be very personal.
Well, I don't know. People do sue over all sorts of things I wouldn't
want to make public. Whatismore, even if they don't sue, they do talk
to their doctors, or answer questionnaires. The fact is, neither
doctors nor researchers who have conducted large scale post vasectomy
studies, report high incidences of chronic pain. And frankly, I just
don't believe that men faced with longterm swelling and discoloration
of their sexual organs (to which you allude) would keep it secret,
ESPECIALLY if they thought a medical procedure were to blame.
trifold
> the true risk factors.
Why do you say no "real studies?" Why don't you explain to us what is
wrong with the studies that have been conducted, to which we have
often referred here.
>There are lots of examples of the medical
> establishment having too much faith in their own procedures or
> protocols. It took congressional legislation to allocate money for the
> women's HRT study that was free of biases of sponsors (like
> Schwingle).
Why do you say Schwigel is biased in the same way as a drug company?
What about Guess? Here you are attacking people personally (Schwingel
and Guess + the editors of the journal in which they published)
without giving cause. This is irresponsible. It suggests you cannot
deal with their science. It is cowardly.
>Lately the news reports that Bayer was aware of the
> dangers of Baycol before they put it on the market, but went ahead
> anyway and did report their internal findings to the FDA while going
> through the process to have it approved is an example that you must
> err on the side of safety when it comes to your own health.
You are choosing to ignore the fact that scientists at one point did
fear vasectomy might be dangerous. The American Urological
Association once even adviced doctors to test vasectomised men more
regularly for prostate cancer. As a result of these concerns, they
conducted more research, designing studies specifically looking for an
association between vasectomy and prostate cancer. The result of this
research was that the feared linkage was not found.
>
> If you have lurked here for anytime at all you will see references to
> studies that show damage to the endocrine system of men who undergo
> vasectomy, yet rather than acknowledge this risk, folks will go to
> lengths to rationalize away these studies.
You say damage to the endocrine system. Such damage would result in a
breakdown in T production. While some studies show some change in
some men in some endocrine readings, NO STUDY SHOWS A REDUCTION IN
HUMAN T PRODUCTION LINKED TO VASECTOMY, EVEN THOUGH STUDIES HAVE
LOOKED FOR THESE CHANGES. If this is wrong, point to a study.
>Same with Prostate cancer.
See above.
> Same with PVP (the silliest - your PVP is due to regret because your
> wife forced you to have a vas).
These studies have been conducted.
>
> As to litigation. It is harder than you think. Every Urologists or
> surgeon just points to the AMA and says I followed 'the standard duty
> of care' for this procedure. It takes pretty deep pockets to go
> against the AMA and Insurance companies who would have a lot to loose
> once the first case of vasectomy tort was won. Look to the 40-50 years
> of cigarette litigation and the clearer link established between
> smoking and disease as an example.
Cigarette suits were brought against tobacco companies. As for the
difficulty of suing doctors, if it were so hard, how come malpractice
insurance is so high?
David
> Hello David -- I have taken public stands many times on public
> policy issues but have never done so about my PVP because it is a
> personal matter and embarassing. I would not be suprised if 99%
> of people would choose not to publically talk about pain, soreness,
> swelling, discoloration, etc. in their sexual organs. To most
> people, I think, this would be very personal.
I agree with this - if it were any other part of the body men would indeed
be more inclined to take a public stand.
That said, if you take a look at the numbers involved, and take an extremely
conservative view of the numbers that would be prepared to speak openly,
then the hardcore of men what would statistically be prepared to take a
stand should theoretically be very, very much higher than what we see -
hence the confusions referred to in the early part of the thread.
OK, I'll just refer to US figures to make life a bit easier.
Anually 500,000 - 600,000 men have a vasectomy. Complication rates vary very
widely depending on what you are reading and what you believe. They vary
from 0-30%, but I'll go with the generally accepted reported incidence rates
of CTP (safety and effetctiveness) of 1-1.8%. In fact I'll stick to the
lower rate for the purpose of illustration.
OK, so say 1% of the people above have unresolved CTP issues after three
months, that's 5,000 men per annum. Say that 99% of them are not likely to
go public, you still end up with what amounts to a sizeable pressure group
(if they chose to be) from one years figures alone. Compound that year on
year, and theoretically a very large, vociferous pressure group could exist.
I accept that some under reporting is bound to happen, so if you add these
unreported statistics in, that swells the ranks of the "could be" pressure
group considerably. The figure's I'm using are the very conservative ones.
The question earlier in the thread basically amounts to "Where are they?".
I can understand that men would not want to stand on a soap box, but even so
there is still potentially a decent enough potentiol number of people
prepared to be loud, and to make news.
The other part of the question is "Where are they on the internet?". With
the complete anonimity of the net, then surely more would be prepared to
come forward, at least to tell their story anonymously.
PVP on the net isn't new - it was an issue when we first started the
newsgroup, and the loudest of anti-vasectomy sites has been online for three
years to my knowlege. There are two unmoderated newsgroups on vasectomy, yet
the total postings per month to both groups combined is less that a UK
newsgroup that I occasionally read on "What is the cheapest place to buy
screws and nails this week" get in a week! And a lot of the posts aren't
about PVP.
Steve will of course say that it's all Trifold and my fault, but there is
even less posting and discussion of pvp at the yahoo group than here, and
neither of us post there.
Why aren't they using the internet to organise themselves? Good question,
and one I can't answer.
David
www.vasectomy-information.com
David
> I did not report my
> PVP to a doctor until my testosterone dropped.
So what made you think yout testosterone had dropped in the first place? Why
when you had pains did you not report them bearing in mind the amount of
reading you say you do?
> Same with Prostate cancer.
As you are avoiding the issue in the other thread, maybe you'd like to take
this opportunity to explain your rationale in concluding completely opposite
to the authors report of studies and papers on the research, and why you
conclude differently to the AUA, WHO given the same set of data?
> Same with PVP (the silliest - your PVP is due to regret because your
> wife forced you to have a vas).
I know this is a dig at me - why don't you just come out with it Steve?
Maybe you think it's silly, but unlike a lot of what you post it's at least
got a credible basis in fact. Unlike, your "Doctors and vasectomy",
"Shrinking/growing balls", "Shrinking/growing testicles" and "Don't have a
vasectomy and you won't get heart disease" ideas all of which you just
simple made up.
The facts behind this are that the "Well connected" and "Safety and
effectiveness" both go into the phsycological aspects of regret, in the
vasectomy/ED threads I posted a Swiss paper that looked at vasectomy and ED
and found that a "predominant wife" was a very considerable part of the
problem, and the online survey has always come up with 70%+ of men with pvp
claiming their wife was the first to suggest it. Also, if you read the
stories, it's a common theme.
That said, the most astounding thing here is how I use it and why you
object!!! It's always been my argument that men who regret vasectomy
frequently do so
because they had it done under pressure. I use the argument to those
considering
vasectomy that are
doing it under pressure as a reason not to go ahead. I don't use it to
explain away PVP in those that have it. Why you object to this, and why you
don't use the argument yourself is a mystery.
You are no stranger to the phsycological aspects yourself - you blame all
your
ills on vasectomy. You are going to be mightily pissed off when you die at
the grand old age of 90+ of natural causes and the coroner (or whoever) does
not list "vasectomy" as cause of death!!
One of the ills you blame on vasectomy is your apparent decline in
testosterone. Consider what you have freely admitted is fact in this
newsgroup on the topic.
1. You did not have a baseline measure established before you had a
vasectomy.
2. You do not know *IF* your T levels varied after vasectomy, let alone
when.
3. Reversal did not alter your levels, but they *did* change some years post
reversal, around the time you co-incidentally changed your diet and fitness
regime.
I doubt there are many that would see the above as what you claim it to be.
> As to litigation. It is harder than you think. Every Urologists or
> surgeon just points to the AMA and says I followed 'the standard duty
> of care' for this procedure. It takes pretty deep pockets to go
> against the AMA and Insurance companies who would have a lot to loose
> once the first case of vasectomy tort was won.
"Was"? you use the past tense as though there was a case. Please provide
details.
> This is why I still post here and take the flames as a result, so that
> men who question the rationale know they are not alone in wondering
> what makes sense.
Before you go too far with the "Martyr" thing you seem keen on currently,
consider what actually happens here. You and others don't get flamed for
posting anti-vas opinions. That's perfectly on-topic. You do get asked to
provide evidence of specific claims, or what you claim as facts, yet you
never do. Nor do you share with us the rationale behind why you conclude the
exact opposite from the AUA, WHO and writers of reports and studies given
the same data.
Men with PVP do know they are not alone - how your simply making up "facts"
helps them is a question you have never explained. I don't suppose you are
about to either.
Rick
I think that the risk is much greater if the doctor is
not a good surgeon or up to par with current knowledge.
One doctor told me that the overall risk was zero. A
bunch of them told me that the risk was very, very small.
One of those reluctantly told me, when I pressed him,
that the risk of serious, longterm problems was about 1%.
Another uro told me that he never has performed a V and
never would because he thought that the risk was too high.
This was all in the 80's.
As a result of my very bad outcome, I have seen many
doctors and not one of them has ever expressed any interest
in finding out what went wrong. Not one, ever.
It is my belief that no one in the medical establishment
has ever looked for people with PVP in order to document
those cases. Because, if there were, I would have found
them.
Rick
Giraud
> If you have lurked here for anytime at all you will see references to
> studies that show damage to the endocrine system of men who undergo
> vasectomy, yet rather than acknowledge this risk, folks will go to
> lengths to rationalize away these studies. Same with Prostate cancer.
> Same with PVP (the silliest - your PVP is due to regret because your
> wife forced you to have a vas).
I know it sounds absurd to say that emotional state or "thinking" can
induce perceived pain, but I have two personal examples:
1) My low-level right testicle pain that has been there on and off for 20
years got a little more noticable a week or so *before* my vasectomy. I
draw a direct correlation to thinking about the operation and my pervious
pain (note that it was mostly gone for some 15 years, but I could feel
something slight now and then).
2) Now, when I am feeling any pain or pressure "down there" at all, if I
become stressed out, which has happened at work and home recently, the pain
gets worse! Interesting! So either there is a strong mind-body
connection, especially with regards to this sensative area of the body, or
my blood pressure rises or some other physical thing happens.
So it's not absurd, I don't think. If someone *really* regrets having a
vas (and geez, especially if there is resentment toward one's wife that she
"did this to him"), I can imagine it could amplify any pain down there. I
don't understand this, but it seems possible.
Giraud
Rick
trif...@netscape.net (trifold) wrote:
>
> Anonymous...@See.Comment.Header (Rick) wrote in message news:
> r -
> > Hello David -- I have taken public stands many times on public
> > policy issues but have never done so about my PVP because it is a
> > personal matter and embarassing. I would not be suprised if 99%
> > of people would choose not to publically talk about pain, soreness,
> > swelling, discoloration, etc. in their sexual organs. To most
> > people, I think, this would be very personal.
>
> Well, I don't know. People do sue over all sorts of things I wouldn't
> want to make public.
I was not talking about sueing. I was responding to "standing
on a soapbox" which I read as taking a public stand on a public
issue. I would not equate a private legal matter with taking
a public stand on a public policy issue.
>Whatismore, even if they don't sue, they do talk
> to their doctors, or answer questionnaires.
I have talked to more than two dozen doctors about this
very private matter
>The fact is, neither
> doctors nor researchers who have conducted large scale post vasectomy
> studies, report high incidences of chronic pain.
I have never been asked to participate in any study and I
have never seen or heard any advertisements asking for people
to participate in such a study. Not once in twenty seven years.
>And frankly, I just
> don't believe that men faced with longterm swelling and discoloration
> of their sexual organs (to which you allude) would keep it secret,
> ESPECIALLY if they thought a medical procedure were to blame.
Frankly, You are way off base with your hostile attitude and
mis-reading of my post. I never said that people with PVP would
keep that fact a secret from doctors. And, I never said that
people with PVP would not sue anyone. In fact, I saw many
doctors and eventually sought a legal remedy.
But I never publically announced my PVP to friends, relatives,
the press, or the world because I consider it to be a very
private matter. And, I can easily understand why
someone with PVP or the above symptoms would also consider it
to be a private matter.
My understanding is that a consultation with a doctor or lawyer
is a private matter as opposed to taking a public stand on a
public policy issue.
Rick
Steve Law
No personal attacks were intended at you directly or indirectly.
Nor will I participate in our past multiple and long back and forths;
I gave them up for lent.
Steve L
Steve Law
You make too many points in your two posts for me to address. We have
been down this path before. You point to a few studies and ignore the
rest. I say look at all the studies. I say decide on the total.
Example: You say look at the New Zealand prostate cancer study which
shows no connection and ignore the studies in the table in Schwingle
that show a connection despite the dozen of studies showing a
connection with number of participants that are great.
btw: 'Schwingle' is short for the study and don't mean to intend to
focus on one author. If the first author had been Guess, I would have
used that as the short. If I refer to a particular author I believe it
is clear from the context.
If the safety of vasectomy was based on amount of letters typed into a
post and indignation of tone, then you win the argument.
Steve L
Rick
Good question and good analysis. If there is a sleeping giant,
why hasn't he awakened. I don't know either. The only thing
that comes to me is maybe the vast majority of middle aged and
older people are not computer literate. I just found this group
after 27 years with PVP which I never heard about before last
month.
Rick
David
> You point to a few studies and ignore the
> rest. I say look at all the studies.
Ah - if only this were true eh Steve? We might use studies to illustrate a
paticular point, but we also ask people to look at Medline and do their own
research. You on the other hand want to lock people down to crank websites,
books etc. But in the main you just spout on without ANY reference to your
claims.
> I say decide on the total.
> Example: You say look at the New Zealand prostate cancer study which
> shows no connection and ignore the studies in the table in Schwingle
> that show a connection despite the dozen of studies showing a
> connection with number of participants that are great.
Steve - you yet again avoid the question. Clearly as you cannot answer it.
We cite a bunch of studies on the topic, not just the one. Schwingle Guess
CLEARLY CONCLUDES that there is no causal link - the table referred to
tabulates SOME of the studies referred to in the text. In the main it
tabulates ones that may be interpreted as having a risk factor, and the text
discusses them and other materials it uses to form the conclusion.
You cannot simply re-write the conclusion of a report on the grounds that
you don't like it, nor can you dismiss the studies YOU wanted (long term,
large scale ones) on the grounds of "Wrong answer". You have repeatedly
dismissed all of the long term prostate cancer/heart disease/testosterone
studies because the results are not what you want.
David
www.vasectomy-information.com
David
question,
> > and one I can't answer.
>
> Good question and good analysis. If there is a sleeping giant,
> why hasn't he awakened. I don't know either. The only thing
> that comes to me is maybe the vast majority of middle aged and
> older people are not computer literate.
My understanding of it is that it's not an "age" thing, so I doubt this is
the explanation.
BTW, you made a point about non-participating in studies. I don't know how
participation happens, and I doubt if there is a universal way they get
study participants either. My guess is that if a doctor is running or
participating in a study he would simply ask his patients to participate. We
got asked to be part of a trial at the local teaching hospital when one of
the kids was born, and I do know of one UK doctor who did a study who just
asked his patients to join in.
It may be worth asking your doctor how you go about participating in
research next time you see him.
David
www.vasectomy-information.com
ROB
I think he still wins, you still have no proof of your foolish
claims !! Once again get a life!!
ROB
Rick
> r -
> > Hello David -- I have taken public stands many times on public
> > policy issues but have never done so about my PVP because it is a
> > personal matter and embarassing. I would not be suprised if 99%
> > of people would choose not to publically talk about pain, soreness,
> > swelling, discoloration, etc. in their sexual organs. To most
> > people, I think, this would be very personal.
>
> Well, I don't know. People do sue over all sorts of things I wouldn't
> want to make public.
I was not talking about sueing. I was responding to "standing
on a soapbox" which I read as taking a public stand on a public
issue. I would not equate a private legal matter with taking
a public stand on a public policy issue.
>Whatismore, even if they don't sue, they do talk
> to their doctors, or answer questionnaires.
I have talked to more than two dozen doctors about this
very private matter
>The fact is, neither
> doctors nor researchers who have conducted large scale post vasectomy
> studies, report high incidences of chronic pain.
I have never been asked to participate in any study and I
have never seen or heard any advertisements asking for people
to participate in such a study. Not once in twenty seven years.
>And frankly, I just
> don't believe that men faced with longterm swelling and discoloration
> of their sexual organs (to which you allude) would keep it secret,
> ESPECIALLY if they thought a medical procedure were to blame.
Frankly, You are way off base with your hostile attitude and
mis-reading of my post. I never said that people with PVP would
keep that fact a secret from doctors. And, I never said that
people with PVP would not sue anyone. In fact, I saw many
doctors and eventually sought legal advice.
But I never publically announced my PVP to friends, relatives,
the press, or the world because I consider it to be a very
private matter. And, I can easily understand why
someone with PVP or the above symptoms would also consider it
to be a private matter.
My understanding is that a consultation with a doctor or lawyer
is a private matter as opposed to taking a public stand on a
public policy issue or "standing on a soapbox".
Rick
Rick
I think that the risk is much greater if the doctor is
not a good surgeon or up to par with current knowledge.
One doctor told me that the overall risk was zero. A
bunch of them told me that the risk was very, very small.
One of those reluctantly told me, when I pressed him,
that the risk of serious, longterm problems was about 1%.
Another uro told me that he never has performed a V and
never would because he thought that the risk was too high.
This was all in the 80's.
As a result of my very bad outcome, I have seen many
doctors and not one of them has ever expressed any interest
in finding out what went wrong. Not one, ever.
It is my belief that no one in the medical establishment
has ever looked for people with PVP in order to document
the incidence of those cases. Because, if there were,
Rick
"David" <david...@tesco.net> wrote:
>
> > > Why aren't they using the internet to organise themselves? Good
> question,
> > > and one I can't answer.
> >
> > Good question and good analysis. If there is a sleeping giant,
> > why hasn't he awakened. I don't know either. The only thing
> > that comes to me is maybe the vast majority of middle aged and
> > older people are not computer literate.
>
> My understanding of it is that it's not an "age" thing, so I doubt this is
> the explanation.
My experience is different from yours. Here is the way I see it.
The big majority of my friends do not use computers and none of
their parents use them. But, just about all their kids do use
them. Kids now learn about computers in school. For those and
other reasons, I conclude that age is a big factor.
Here is another reason. It is easy to learn how to do something
if someone shows you. But it is very time consuming to learn
about computers by trial and error, and reading manuals.
I am willing to bet that you have spent many hours learning
your computer skills. I know that it took me many hours and I
am still learning. Last night, I sent three posts to this group
and only one showed up.
Of course, it is possible that I am the only person in the world
with longterm PVP or the incidence is less than 1 in 40,000.
Another reason might be that victims of PVP do not want to use
their real names so they would have to learn how to use anon
remailers which is a whole new kettle of fish. I know because
I did it.
And, I think you said that this site is only two years old.
Maybe more time is needed.
Is their any comparison to breast implants
in women? I remember reading somewhere that female problems
such as breast cancer get more attention than male problem's
such as prostate cancer.
>It may be worth asking your doctor how you go about participating in
>research next time you see him.
I was making a point that the medical establishment was not
interested in documenting the incidence of PVP. There are
more than two dozen doctors and several medical organizations
who know about my PVP and none of them have ever reported
it to anyone. I have never been contacted by anyone about
this problem. And, no doctor has ever been interested in
finding out what went wrong in order to prevent this disaster
from happening to someone else. Not one, ever.
Rick
David
> > My understanding of it is that it's not an "age" thing, so I doubt this
is
> > the explanation.
>
> My experience is different from yours.
I may not have explained this very well. I wasn't referring to the abilities
to communicate online of pvp sufferers, but to the age groups of men
suffering. My comment that it doesnt seem to affect any paticular agegroup
(esp. older people) is based on the threads here (and the previous deja
group), the people who submit their story, and the responses to the group
website's online survey.
I don't have an answer to the "sleeping giant still asleep" question, nor do
I pretend to. But I do have some insights that may be of interest.
> Here is the way I see it.
>
> The big majority of my friends do not use computers and none of
> their parents use them. But, just about all their kids do use
> them. Kids now learn about computers in school. For those and
> other reasons, I conclude that age is a big factor.
"One datapoint doesn't make a survey" is a much hackneyed phrase, and my
experience of this in my circle is different. However that data point
doesn't make a survey either! One thing I would say is that apart from porn,
genealogy is the second biggest use of the internet by some way. The people
involved in that hobby are predominantly retired people. I have experience
here of this. BTW, if you want to see a real flame war just say the wrong
thing on a rootsweb forum! The "silver surfers" really know how to flame!
Therefore I don't believe that there is a general inability to use, or
access to the internet on the part of the older generation. Or at least
insomuch as it would particularly skew statistics on the issue.
>
> I am willing to bet that you have spent many hours learning
> your computer skills. I know that it took me many hours and I
> am still learning. Last night, I sent three posts to this group
> and only one showed up.
I get problems with my ISP too - mostly they go slow and tell me that my
posts are "No longer available on the server" despite only just being sent.
>
> Another reason might be that victims of PVP do not want to use
> their real names so they would have to learn how to use anon
> remailers which is a whole new kettle of fish. I know because
> I did it.
Using a "net name" is the standard advice of ISP's this side of the pond.
You don't even need to go as far as anon remailers - just set up a new
account with your ISP (or hotmail/yahoo etc) with a net name of your choice.
Trifold isn't his real name, my real name isn't "David Brown" and I doubt
very much if Steve Law is really called that either. Net names are standard
practice.
>
> And, I think you said that this site is only two years old.
> Maybe more time is needed.
That isn't what I said.
I've been involved online in either this (or the previous) group for five
years now, and been the webmaster for best part of 4 years. The reference
above is to Kevin Haubers site that has been online for three years (to my
knowledge).
In the time I've been involved online, posting rates have been fairly
static, and various sites on pvp have come and gone. But in general there
hasn't been an increase of activity in both vasectomy general info, or
specific info on pvp in that time. Whereas most areas of the net have
mushroomed exponentially. I personally think this is not a conspiracy but
general lack of interest (sadly).
I have a good insight into how people use the net for vasectomy info. IE
what search strings are used, what they find on the searches etc. As
webmaster I have been analysing the site logs for a long time. Some 98%+ of
vasectomy searches use the keyword vasectomy, or phrases that imply general
information searches such as vasectomy info, vasectomy faq etc etc etc. Very
few searches are ones where the person is looking for specific pvp info, and
sites that deal in that generally speaking have very poor search engine
rankings. I could have shown you this a month or so ago, but I've offlined
that facility as it caused longer than necessary page loading times, and
it's a bit monotonous looking at what seems to be the same data for years on
end :( . I was going to move to a different webhost where I would have had
different facilities, but we are now staying put.
> Is their any comparison to breast implants
> in women? I remember reading somewhere that female problems
> such as breast cancer get more attention than male problem's
> such as prostate cancer.
I hadn't heard this, but if that's the case it's because women make it so by
being keener to go public.
>
> >It may be worth asking your doctor how you go about participating in
> >research next time you see him.
>
> I was making a point that the medical establishment was not
> interested in documenting the incidence of PVP. There are
> more than two dozen doctors and several medical organizations
> who know about my PVP and none of them have ever reported
> it to anyone. I have never been contacted by anyone about
> this problem. And, no doctor has ever been interested in
> finding out what went wrong in order to prevent this disaster
> from happening to someone else. Not one, ever.
I understand the point you are making here, but my point still remains. If a
survey is happening at the same place and time you are being treated it's
likely they would ask as many people as possible to participate. Our local
hospital is a major teaching hospital, and you don't get anything done there
without a student or two lurking, yet we were only asked to participate in
one study some years ago by a sheer fluke. If you just happen to live
outside the catchment area of a hospital that does research the chances of
being asked to help with research are pretty low I'd say.
Did I read your response to Trifold correctly in that you have taken legal
redress against a doctor?
ROB
This is something that I've been thinking about as well. With the
closed ended procedure there is more risk of pinching a nerve in the
clips or in the suture on the testicle end. My uro said that the
possibility of long term pvp was less than 10%. He also told me that
is one reason that he WOULD NOT perform a closed ended under any
circumstances!He also told me at the initial consultation that he does
2-5 conversions to open ended each month.
> One doctor told me that the overall risk was zero. A
> bunch of them told me that the risk was very, very small.
> One of those reluctantly told me, when I pressed him,
> that the risk of serious, longterm problems was about 1%.
> Another uro told me that he never has performed a V and
> never would because he thought that the risk was too high.
> This was all in the 80's.
One of the first things out of the first uro that I saw was " I
guess you've heard stories or read stories on the internet saying that
your scrotum swells up so large they'll fill a wheel barrow." And
proceeded to try to pull them off during the consult. He was a real
piece of work. He also said that there was no risk of pvp, something
that isn't possible or we wouldn't be having this conversation.
>
> As a result of my very bad outcome, I have seen many
> doctors and not one of them has ever expressed any interest
> in finding out what went wrong. Not one, ever.
I don't know what to tell you about this other than if mine went/
goes wrong and they turn the cold shoulder to me he'll pay and dearly
in court. I have np problem discussing anything with anyone. I'm a
former RANGER medic and there isn't very much I haven't seen.
> It is my belief that no one in the medical establishment
> has ever looked for people with PVP in order to document
> the incidence of those cases. Because, if there were,
> I would have found them.
>
If you're in the Balto metro area shoot me an email and I'll put you
in touch with my uro.
Good medicine,
Greenfeather
> Rick
trifold
> mis-reading of my post. I never said that people with PVP would
> keep that fact a secret from doctors. And, I never said that
> people with PVP would not sue anyone. In fact, I saw many
> doctors and eventually sought a legal remedy.
Whoa, man. I wasn't being hostile. I was simply saying I believe if
pvp were a big problem for lots of men, we would have heard more about
it, becuase they would be suing doctors and/or their experience would
be showing up in medical studies. I didn't mean to say anything at
all about you.
>
> My understanding is that a consultation with a doctor or lawyer
> is a private matter as opposed to taking a public stand on a
> public policy issue.
Yes, of course. But such private consultations would end up having a
public consequence. For example, instead of being widely recongnized
in medical literature as one of the safest medical procedures around,
vasectomy would be seen as risky and ill-advised.
trifold
> trifold,
>
> You make too many points in your two posts for me to address.
Sorry to confuse you, Steve. Maybe you should read, read, read. . .
>We have
> been down this path before. You point to a few studies and ignore the
> rest. I say look at all the studies.
I haven't ignored studies. I agree with Schwingel and Guess--and lots
of scientists--that some studies are better than others. Can you
explain why you believe old studies that suggest vasectomy is
associated with prostate cancer are more credible than studies that
followed--and that specifically addressed the concerns raised by the
earlier studies? Let's talk specifics.
> Example: You say look at the New Zealand prostate cancer study which
> shows no connection and ignore the studies in the table in Schwingle
> that show a connection despite the dozen of studies showing a
> connection with number of participants that are great.
Can you say "detection bias"?
>
> btw: 'Schwingle' is short for the study and don't mean to intend to
> focus on one author. If the first author had been Guess, I would have
> used that as the short. If I refer to a particular author I believe it
> is clear from the context.
You have sought to discredit the Schwingel & Guess study saying
Schwingel is a woman. So it was natural for me to ask about Guess.
(And can you explain again why being a woman makes a person a bad
scientist?)
trifold
Dave
I felt I had to add a few points from personal experience.
I have experienced PVP and low Testosterone Levels.
(why did I originally have my T levels checked ? I was experiencing
Impotence).
I had a Vas in 1995. No pressure from my wife.
PVP started 1997.
ED started 1998.
T-levels measured between 1998 and 2002 ranged between 6 and 10 nmol/L
(UK scale). "Normal" range is about 10->30.
I had a Vas Reversal in Nov 2002.
PVP is now gone.
ED remains, although T level has been measured several times since
reversal and last one was 10.2nmol/L. This is the best number since
1998 ! So is my T-level now increasing ? Its too early to tell
although I am hopeful following Steve Law's experience.
I had a consultation with an Endo in Dec 2002. He asked me what "I"
thought had caused these low-T levels. I said that in my opinion
it was the original Vasectomy, but that I know there is no proof that
Vasectomy causes low-T. He stated that it would be a good PhD project
for someone to undertake !
Just because there is no proof of something, surely it cannot be
ruled out ?
Dave (miami_vice_1999)
Steve Law
Quickly then done with this thread:
Detection Bias - Schwingle states that Giovanucci looked for detection
bias and found that no detection bias effected the stats of increased
rate of prostate cancer risk due to vasectomy - something you ignore.
[Page 931, Schwingle states detection 'may' be a factor with no
backup, just conjecture, and then at the end states 'indicating that
detection bias was unlikely to appreciably affect result.'] And you
wonder why I say you continue to misrepresent detection bias and other
things and thus tire of responding.
Schwingle, herself: Don't know the woman. Just like you don't know me.
That doesn't stop us from quessing at motive (you have even called me
many names and placed motives on me). Schwingle is associated with a
pro-women's health group. David and you question any TRT studies and
motives from pro-TRT groups. The study uses terms like 'may' to
dismiss vasectomy concerns (see above) without backing. The study
underplays endocrine damage by placing it near the end under the
heading, "Other" and not including the many studies showing endocrine
damage at the time of the report. All I stated is that as a woman
working for a pro-women's health organization there 'may likely' be
some prejudice. The same 'may likely' she uses.
But of course according to you anyone espousing the safetly of
vasectomy 'may likely' be 100% accurate; and only the nay sayers are
'may likely' wrong in fact and motive.
Steve L
Rick
mrtwe...@prodigy.net (ROB) wrote:
Hello Greenfeather -- Thanks for your input and understanding.
And thanks for your email offer. It is much appreciated.
It seems to me that your medical knowledge prior to your
V, greatly reduced your risk. Your knowledge led you to
a good doctor which is a big plus.
My V doctor (a general practioner) knew nothing about
the merits of different procedures or nerve damage. And,
I knew nothing either. The result of this ignorance was
a disaster.
Rick
Rick
"David" <david.b...@ntlworld.com> wrote:
Hello David -- Thanks for your comprehensive response.
I will add a few comments and hope that you don't mind if
I edit your post.
> genealogy is the second biggest use of the internet by some way. The people
> involved in that hobby are predominantly retired people. I have experience
> here of this. BTW, if you want to see a real flame war just say the wrong
> thing on a rootsweb forum! The "silver surfers" really know how to flame!
>
> Therefore I don't believe that there is a general inability to use, or
> access to the internet on the part of the older generation. Or at least
> insomuch as it would particularly skew statistics on the issue.
This is where we disagree. Yes, there probably are many "silver
surfers. But I strongly suspect that they are a small percentage
compared to the total number of silvers.
It is my unscientific opinion that most old dogs are reluctant to
learn new tricks.
It may be interesting to find the stats about the percentage of
surfers between 12 and 25 or 30 years old and the percentage
of those over 30 who surf.
> > I am willing to bet that you have spent many hours learning
> > your computer skills. I know that it took me many hours and I
> > am still learning. Last night, I sent three posts to this group
> > and only one showed up.
>
> I get problems with my ISP too - mostly they go slow and tell me that my
> posts are "No longer available on the server" despite only just being sent.
> >
> > Another reason might be that victims of PVP do not want to use
> > their real names so they would have to learn how to use anon
> > remailers which is a whole new kettle of fish. I know because
> > I did it.
>
> Using a "net name" is the standard advice of ISP's this side of the pond.
> You don't even need to go as far as anon remailers - just set up a new
> account with your ISP (or hotmail/yahoo etc) with a net name of your
choice.
>
> Trifold isn't his real name, my real name isn't "David Brown" and I doubt
> very much if Steve Law is really called that either. Net names are standard
> practice.
You are making my point that the contributors to this group are
computer literate. They are definitly not newbies. I did take
the extra step and learned about anon remailers. And, I can tell
you that it is quite complicated. I have an anon email address
that, theoretically, cannot be traced to me. It is so private that
it does not even get any spam! I used it to send a post to your site.
> In the time I've been involved online, posting rates have been fairly
> static, and various sites on pvp have come and gone. But in general there
> hasn't been an increase of activity in both vasectomy general info, or
> specific info on pvp in that time.
Very interesting. Let the group know if it changes.
> > Is their any comparison to breast implants
> > in women? I remember reading somewhere that female problems
> > such as breast cancer get more attention than male problem's
> > such as prostate cancer.
>
> I hadn't heard this, but if that's the case it's because women make it so
by
> being keener to go public.
It sounds like, "The squeaky wheel gets the oil."
> > >It may be worth asking your doctor how you go about participating in
> > >research next time you see him.
> >
> > I was making a point that the medical establishment was not
> > interested in documenting the incidence of PVP. There are
> > more than two dozen doctors and several medical organizations
> > who know about my PVP and none of them have ever reported
> > it to anyone. I have never been contacted by anyone about
> > this problem. And, no doctor has ever been interested in
> > finding out what went wrong in order to prevent this disaster
> > from happening to someone else. Not one, ever.
>
> I understand the point you are making here, but my point still remains. If
a
> survey is happening at the same place and time you are being treated it's
> likely they would ask as many people as possible to participate. Our local
> hospital is a major teaching hospital, and you don't get anything done
there
> without a student or two lurking, yet we were only asked to participate in
> one study some years ago by a sheer fluke. If you just happen to live
> outside the catchment area of a hospital that does research the chances of
> being asked to help with research are pretty low I'd say.
I have been thinking about this will say something later. The
common sense thing to do is to require doctors to report all bad
outcomes to a central location. And not just PVP but all bad
reactions to surgeries and drugs so that consumers of medical
services can have all the facts and all the percentages in
order to make informed decisions or informed consent.
> Did I read your response to Trifold correctly in that you have taken legal
> redress against a doctor?
Yes.
Rick
Rick
> > Frankly, You are way off base with your hostile attitude and
> > mis-reading of my post. I never said that people with PVP would
> > keep that fact a secret from doctors. And, I never said that
> > people with PVP would not sue anyone. In fact, I saw many
> > doctors and eventually sought a legal remedy.
>
> Whoa, man. I wasn't being hostile.
Maybe "hostile" was the wrong word but I will stick with
"mis-reading". You said,
"And frankly, I just
don't believe that men faced with longterm swelling and discoloration
of their sexual organs (to which you allude) would keep it secret,
ESPECIALLY if they thought a medical procedure were to blame.
I did not say that they would keep it secret.
>I was simply saying I believe if
> pvp were a big problem for lots of men, we would have heard more about
> it, becuase they would be suing doctors and/or their experience would
> be showing up in medical studies.
I did not say that PVP was a big problem for lots of men.
> > My understanding is that a consultation with a doctor or lawyer
> > is a private matter as opposed to taking a public stand on a
> > public policy issue.
>
> Yes, of course. But such private consultations would end up having a
> public consequence.
Not in my case. At least two dozen doctors and two medical
organizations were made aware of my bad outcome and not one
of them reported it to anyone or any database.
>For example, instead of being widely recongnized
> in medical literature as one of the safest medical procedures around,
> vasectomy would be seen as risky and ill-advised.
I do not know how safe it is for others. I do know that it
was not safe for me. I also know that my bad outcome
was covered up and not reported. And I have met a bunch of
doctors who will not treat bad outcomes and do not want to
know anything about them. Not one doctor has ever tried or
shown any interest in finding out the cause of my bad outcome.
And not one of them has ever offered an explanation for my
bad outcome.
The first time that I heard the word "PVP" or "nerve damage"
was about one month ago on the internet (this group)
in spite of the fact that I have suffered from it for twenty
seven years, have seen many doctors, and have been hospitalized
for it twice.
Rick
Steve Law
You are posting to a wall. Trifold belongs to that group that believes
there is no real PVP (all mental), that the safety of the procedure is
beyond doubt, and that the medical establishment has no biases, none
what so ever. Mr. Trifold believes all negative reports on vasectomy
are due to either detection bias or 'my wife made me do it syndrome.'
God's Speed,
Steve L
ROB
Rick,
I researched for 6 months before I comitted to having a vasectomy. I
heard all of the old wives tales from it causes prostate cancer , your
balls will swell up to the size of a basketball and you get the
injection in the testicles. The first uro that I saw said and did
something that troubled me greatly. Some of the first things out of
his mouth were" I guess you've heard the stories about how you scrotum
sweels up and you have to cart it around in a wheelbarrow". Then he
proceeded to try to disconnect my testicles by hand. It took all of my
patience not to break his neck ! Needless to say he wasn't the one
that did my surgery. I was sore for 2 days after the initial consult,
if your pain is anything like the first day after that exam, I'll do
RANGER School again thank you very much!
Good medicine,
Greenfeather
De Opresso Liber
trifold
I have frequently posted at this ng advising men how to deal with pvp.
I have also advised them to seek legal help when it seemed they had
been badly treated by their doctors. I have never denied pvp occurs.
You, Steve, are truth-challenged.
trifold
>
> has ever looked for people with PVP in order to document
> those cases. Because, if there were, I would have found
> them.
But studies have been done looking for pvp cases. Have you looked in
the medical literature?
trifold
Steve Law
Just chalk it up to my likely detection bias.
Steve L
trifold
>
> The first time that I heard the word "PVP" or "nerve damage"
> was about one month ago on the internet (this group)
> in spite of the fact that I have suffered from it for twenty
> seven years, have seen many doctors, and have been hospitalized
> for it twice.
I am sorry for your experience. Perhaps you should tell us more about
it, so men who want vasectomies can avoid the problems you have
experienced. I hope you will not consider the following comment
hostile, but I do need to say that one reason details of your
situation will be helpful is that your situation is so extremely rare:
all evidence suggests the overwhelming majority of men don't suffer
problems like yours after vasectomy. This leads me to believe
something about your case is special, and by knowing more about your
case, other men can take steps to avoid your bad outcome. Which kind
of vasectomy did you have? How soon after the vasectomy did your pain
develop? What remedies have been attempted? In the meantime, I will
continue to advise men vasectomy is safe and effective, pointing to
the medical evidence: 1) that complications are very rare; 2) that
there are effective treatments for these complications when they
occur.
trifold
> trifold,
>
> Quickly then done with this thread:
You do like "quickly," don't you Steve? Hit and run is your method.
Problem is, thinking takes time.
>
> Detection Bias - Schwingle states that Giovanucci looked for detection
> bias and found that no detection bias effected the stats of increased
> rate of prostate cancer risk due to vasectomy - something you ignore.
First, I don't ignore the words of Schwingl and Guess. Secondly,
let's look at those words carefully, shall we? Here they are (between
asterisks):
*****
Their conclusion re: prostate cancer and vasectomy:
"In summary, although several epidemiologic studies in
which an elevated incidence of prostate cancer was found in
association with vasectomy exist, there are also a number of
large, well-designed studies in which an elevation in risk was
not found. Overall, the weight of the evidence suggests
that there is no association between vasectomy and prostate
cancer."
******
Now what do they say about Giovannucci?:
They mention his studies provided the strongest evidence up to that
time of a connection. They say that the Giovannucci's results seemed
"unlikely" to be influenced by detection bias since in one phase of
his work he restricted comparison to groups of men who had had at
least one DRE. Well and good. But Steve, do Schwingl and Guess's
words stop here? No, Steve, they don't. What do they say next? They
say that:
"Although attempts were made to ascertain the presence of
detection bias in the cohort studies, it was conceivable that
patterns of long-term increasing risk could also be due to
increased opportunity for detection such as that which was
observed in the Honolulu Heart Program (115)."
This means that even if both groups studied by Giovannucci had had "at
least one" DRE, there was still a possibility that BECAUSE the men
were being studied over long periods of time, more prostate cancer
might have been detected, giving a false impression that cancer was
more common among vasectomised men than others. (i.e. the
vasectomised guys might still have had more DRE and other screen tests
than the others). You will insist upon the tentativeness of this
statement, revealed in the phrase, "it was conceivable." But do the
words of Shwingl and Guess end here? No, Steve, they don't. What do
they say next? Let's look, shall we Steve?:
*****
"The combined evidence prompted the National Institutes
of Health (NIH) to convene an expert panel in 1993 to
provide recommendations to clinicians and public health
authorities. However, after review of all existing data, the
NIH panel concluded that, overall, the associations in the
literature to date were weak and that detection bias could not
be ruled out (116). The panel recommended that providers
should continue to offer vasectomy and perform the procedure;
that vasectomy reversal is not warranted to prevent
prostate cancer; and that screening for prostate cancer should
not be any different for men who have had a vasectomy than
for those who have not."
*****
What do you make of these last words, Steve? How do you explain them?
Now, how do you explain the next several paragraphs in the study that
report on subsequent research that also confirms no link?
You don't explain them, Steve. Instead you resort to summarizing
Shwingl and Guess this way:
> [Page 931, Schwingle states detection 'may' be a factor with no
> backup, just conjecture, and then at the end states 'indicating that
> detection bias was unlikely to appreciably affect result.'] And you
> wonder why I say you continue to misrepresent detection bias and other
> things and thus tire of responding.
Why, it is almost as if you hadn't read the rest of Schwingl and
Guess! Or maybe you did read it, but wanted to fool readers into
thinking Schwingl and Guess had said nothing more. That, of course,
would suggest you are truth challenged, wouldn't it Steve?
>
> Schwingle, herself: Don't know the woman. Just like you don't know me.
> That doesn't stop us from quessing at motive (you have even called me
> many names and placed motives on me).
I have said you are truth challenged. And that you try to move people
to your point of view not through reasoned argument but by scaring
them. (I think I used the word "terror.") I have also said you are a
woman basher. I stand by all these claims. Your words below help to
confirm this claim:
> All I stated is that as a woman
> working for a pro-women's health organization there 'may likely' be
> some prejudice. The same 'may likely' she uses.
I don't know what you mean exactly by comparing the use you make of
"may likely" and Schwingl's. She is talking about the likely
explanations for data points. You are talking about likely
explanations for how Schwingl and Guess interpret data. You are very
obviously trying to suggest that because Schwingl is a woman working
in women's health issues, she is distorting data. (Let's leave aside
that you seem also to be suggesting that her collaborator, Guess--and
the editors of the journal that published the study, and presumably
all the scientists who have not contradicted it--have somehow also
been swayed by Shwingl's dastardly concern for women's health, and as
a result have decided to support a procedure that puts the health of
men at risk.) Steve, this is irresponsible, terrorist, ignorant
nonsense. (And you are still truth challenged.)
By the way, you have also failed to discuss subsequent studies, some
specifically designed to eliminate detection bias (e.g. the Washington
State study referenced below):
*****
Cancer Epidemiol Biomarkers Prev 1999 Oct;8(10):881-6
Vasectomy and risk of prostate cancer.
Stanford JL, Wicklund KG, McKnight B, Daling JR, Brawer MK.
Division of Public Health Sciences, Program in Epidemiology, Fred
Hutchinson Cancer Research Center, Seattle, Washington 98109, USA.
jsta...@fhcrc.org
Most studies do not support an association between vasectomy and
prostate cancer, but a few have suggested a link. Vasectomy is a
common birth control method, and prostate cancer is the most
frequently diagnosed solid tumor in men, making this a major public
health question. This study was specifically designed to determine
whether or not vasectomy is associated with risk of prostate cancer.
To examine this issue, we conducted a population-based case-control
study in King County, Washington. Interviews were completed with men
ages 40-64 years newly diagnosed with prostate cancer between January
1993 and December 1996 who were ascertained through the Seattle-Puget
Sound Surveillance, Epidemiology, and End Results (SEER) cancer
registry (n = 753) and with comparison men without prostate cancer
identified from the same general population (n = 703). The odds ratio
(OR) for prostate cancer in relation to vasectomy was assessed. The
prevalence of vasectomy was similar in cases (39.4%) and controls
(37.7%), resulting in no association (adjusted OR, 1.10; 95%
confidence interval, 0.9-1.4). There was no consistent evidence that
risk varied by the age at which vasectomy was performed,
the time since vasectomy, or the calendar period when the vasectomy
was performed. The OR in relation to vasectomy was higher in men with
less aggressive prostate cancer. Risk estimates did not differ
according to age, race, or family history of prostate cancer. This
study suggests that vasectomy is not associated with the risk of
developing prostate cancer. It also provides evidence that
vasectomized men may be more likely to present with earlier-stage,
lower-grade prostate tumors.
******
Now quickly, Steve, run and hide. Or better yet, change subjects and
threads, continuing your truth challenged ways.
trifold
>
> Just chalk it up to my likely detection bias.
>
> Steve L
"Detection Bias" is an innocent error. If your browser had
systematically eliminated all those posts in which I have told men
about medical studies that might help them, that would be detection
bias. Then your false statement about me could be construed as due to
bad data collection that resulted in a database that was incomplete
and selective, inclining you (despite your best efforts) to a false
conclusion. Under the circumstances, though, I think another force is
at work: We'll call it "SLEASE" (as in, "Steve Law Employing Absolute
Shit Everytime").
trifold
http:www.vasectomy-information.com
Rick
> >
> > The first time that I heard the word "PVP" or "nerve damage"
> > was about one month ago on the internet (this group)
> > in spite of the fact that I have suffered from it for twenty
> > seven years, have seen many doctors, and have been hospitalized
> > for it twice.
>
> I am sorry for your experience.
Thank you for your support.
> Perhaps you should tell us more about
> it, so men who want vasectomies can avoid the problems you have
> experienced.
Yes. I have already posted much information about my problems
and I will continue because I do have more to say which may
help others to avoid problems.
>I hope you will not consider the following comment
> hostile,
Your first post to me was the exact opposite of supportive and
completely off-base. You attributed statements to me that were
not true and then proceeded to criticize those statements.
>but I do need to say that one reason details of your
> situation will be helpful is that your situation is so extremely rare:
I have provided MANY details in numerous posts to this group in
the past week. And a three page summary which was also posted,
thanks to David, to the group website. I am suprised that you
did not see any of this considering your interest.
> all evidence suggests the overwhelming majority of men don't suffer
> problems like yours after vasectomy.
I agree that I am an individual human being and not an overwhelming
majority. The details that I gave were about my own situation and
I believe that I made that clear.
>This leads me to believe
> something about your case is special, and by knowing more about your
> case, other men can take steps to avoid your bad outcome.
Yes. I agree that this is very important and I do have more to
say about this. In fact, I finally have a good understanding of
what went wrong.
>Which kind
> of vasectomy did you have? How soon after the vasectomy did your pain
> develop? What remedies have been attempted?
I have answered all these questions in my previous posts.
>In the meantime, I will
> continue to advise men vasectomy is safe and effective, pointing to
> the medical evidence: 1) that complications are very rare;
You can do whatever you want. I have never told you what to do
and I have never attacked or criticized you for your beliefs.
Likewise, I have never put words into your mouth and I never
criticized you for things that you did not say.
>2) that
> there are effective treatments for these complications when they
> occur.
Not in my case for the past 27 years which
includes large quatities of
of prescibed drugs and two corrective surgeries. Please post the
names and contact information for any uros who agree with you
so I can contact them.
Rick
David
been unusually intemperate round here of late, and possibly not the most
representative time for you to join us!
Just a couple of points I'd like to make.
Rick - you may think that stories are self explanatory. Some are, and some
raise questions. OK, I accept that the individual posting the story may feel
they have answered everyone's questions, but often the stories do inspire
people to want to know more, and sometimes people want further clarification
on points answered.
Sometimes people don't want to answer questions - they just wanted to say
what's on their mind, and others may enjoy engaging in further discussion.
But engaging in further dialog (even if individuals feel they have already
answered the question) does often help people, as it's the very question
they want answers on, and people don't necessarily bother with past threads.
You have taken the brave step of going public with your story, and as well
has helping you get things off your chest, it also helps those reading your
story - many of whom are lurkers. Having made the step of going public, you
can be of help to quite a few people by engaging in further discussion, and
that's what I believe is the intent here - not to have an argument.
One point I'd like to discuss is you said in the other post in answer to my
question of "Did you take legal action" - you said "Yes". I know you may not
wish to discuss this here and I understand completely if you don't feel like
it. However, it's a frequently discussed topic here, and one that I believe
would interest and help many people.
OK - nobody really wants a flame war. They are extremely counter
productive, and benefit very few, except the odd reader who just likes
reading a good war of course! It's an unmoderated group (as we always felt
it should be) and tempers can run high - therefore maybe now is not a good
time for any of us to make judgements about each other.
A sort of related/sort of not related point is how various people feel the
issue of PVP should be promoted. There are two very clear schools of though.
Any man suffering from PVP who has decided to go public and raise awareness,
naturally wants to stand on a hill and shout as loud as possible, making as
much noise as possible. I understand this. Of course part of them wants
answers to their own situation, but another part wants to warn others off.
However, the people men in this position are trying to reach are those
contemplating vasectomy, who do not react to the issue in the same way that
they do.
How best to reach those considering is the question, and here is where there
are two schools of though. Firstly, there is the emotive resonse way of
trying to raise awareness, and secondly there is the considered way of
raising awareness.
Men with PVP will pretty much always opt for the first method. An
understandable response, and their websites pretty much follow the pattern
of mr Haubers site. Indeed one recent site a guy was promoting here has
simply just stolen his text and iconography!
The other school of thought is working out how best to appeal to men
considering on a strategic level, and this requires a certain emotional
detachment - IE those that do not suffer PVP. And never the twain can meet
(or agree) it seems. A bit of a shame really as that would be what works
best - both working together.
There is room for both methods, but it's my belief based on a considerable
amount of researching visitor stats and various trends that the more
effective way of getting the message across that "Hey - it's not necessarily
a free lunch" is the considered approach. 98%+ reach the site on the simple
keyword "vasectomy", and 30%+ of those considering it, having read some of
the stories realise that they either need to do more research or just drop
the idea.
David
www.vasectomy-information.com
Rick
Hello David -- Thank you for your thoughtful post.
I must say that you have accurately described many
parts of my situation.
I will continue to post details. I have a lot more
of them.
As far as conclusions, I am now confident that I know
what went wrong in my case and I will post about it.
Two posts by Rob in this thread were very useful to my
particular situation and
have confirmed my suspicions. Anyone who is contemplating
any type of surgery should read those posts because he has
the right attitude and the right approach.
I may also post about some legal experiences. Even though
they are painful, people may be able to learn from my
mistakes.
One more point, I have been having some software problems.
I sent two posts to this group more that 24 hours ago and
they have not showed up on my news reader. I can tell you
and anyone else that the remailer network in conjunction
with the mail to news gateways can be as complicated as
brain surgery.
I hope that my posts don't start showing up double or worse.
Rick
Rick
> >
> > The first time that I heard the word "PVP" or "nerve damage"
> > was about one month ago on the internet (this group)
> > in spite of the fact that I have suffered from it for twenty
> > seven years, have seen many doctors, and have been hospitalized
> > for it twice.
>
> I am sorry for your experience.
Thank you for your support.
> Perhaps you should tell us more about
> it, so men who want vasectomies can avoid the problems you have
> experienced.
Yes. I have already posted much information about my problems
and I will continue because I do have more to say which may
help others to avoid problems.
>I hope you will not consider the following comment
> hostile,
Your first post to me was the exact opposite of supportive and
completely off-base. You attributed statements to me that were
not true and then proceeded to criticize those statements.
>but I do need to say that one reason details of your
> situation will be helpful is that your situation is so extremely rare:
I have provided many details in numerous posts to this group in
the past week. And a three page summary which was also posted,
thanks to David, to the group website.
> all evidence suggests the overwhelming majority of men don't suffer
> problems like yours after vasectomy.
I agree that I am an individual human being and not an overwhelming
majority. The details that I gave were about my own situation and
I believe that I made that clear, and I don't care about any majority.
>This leads me to believe
> something about your case is special, and by knowing more about your
> case, other men can take steps to avoid your bad outcome.
Yes. I agree that this is very important and I do have more to
say about this. In fact, I finally have a good understanding of
what went wrong.
>Which kind
> of vasectomy did you have? How soon after the vasectomy did your pain
> develop? What remedies have been attempted?
I have answered all these questions in my previous posts.
>In the meantime, I will
> continue to advise men vasectomy is safe and effective, pointing to
> the medical evidence: 1) that complications are very rare;
You can do whatever you want. I have never told you what to do
and I have never attacked or criticized you for your beliefs.
Likewise, I have never put words into your mouth and I never
criticized you for things that you did not say.
>2) that
> there are effective treatments for these complications when they
> occur.
Not in my case for the past 27 years which includes large quantities
of prescribed drugs, two corrective surgeries and many doctors.
But I would like to know the email address of any uro who deals
these problems and is not afraid to diagnose them.
Rick
Rick
> >
> > The first time that I heard the word "PVP" or "nerve damage"
> > was about one month ago on the internet (this group)
> > in spite of the fact that I have suffered from it for twenty
> > seven years, have seen many doctors, and have been hospitalized
> > for it twice.
>
> I am sorry for your experience.
Thank you for your support.
> Perhaps you should tell us more about
> it, so men who want vasectomies can avoid the problems you have
> experienced.
Yes. I have already posted much information about my problems
and I will continue because I do have more to say which may
help others to avoid problems.
>I hope you will not consider the following comment
> hostile,
Your first post to me was the exact opposite of supportive and
completely off-base. You attributed statements to me that were
not true and then proceeded to criticize those statements.
>but I do need to say that one reason details of your
> situation will be helpful is that your situation is so extremely rare:
I have provided MANY details in numerous posts to this group in
the past week. And a three page summary which was also posted,
thanks to David, to the group website. I am suprised that you
did not see any of this considering your interest.
> all evidence suggests the overwhelming majority of men don't suffer
> problems like yours after vasectomy.
I agree that I am an individual human being and not an overwhelming
majority. The details that I gave were about my own situation and
I believe that I made that clear.
>This leads me to believe
> something about your case is special, and by knowing more about your
> case, other men can take steps to avoid your bad outcome.
Yes. I agree that this is very important and I do have more to
say about this. In fact, I finally have a good understanding of
what went wrong.
>Which kind
> of vasectomy did you have? How soon after the vasectomy did your pain
> develop? What remedies have been attempted?
I have answered all these questions in my previous posts.
>In the meantime, I will
> continue to advise men vasectomy is safe and effective, pointing to
> the medical evidence: 1) that complications are very rare;
You can do whatever you want. I have never told you what to do
and I have never attacked or criticized you for your beliefs.
Likewise, I have never put words into your mouth and I never
criticized you for things that you did not say.
>2) that
> there are effective treatments for these complications when they
> occur.
Not in my case for the past 27 years.
Rick
Rick
> >
> > It is my belief that no one in the medical establishment
> > has ever looked for people with PVP in order to document
> > those cases. Because, if there were, I would have found
> > them.
>
> But studies have been done looking for pvp cases.
They could not have looked very far or wide. Can you post
any advertisements looking for people with PVP or bad
vasectomy outcomes resulting in serious pain? Do any of
these researchers have a website?
If a researcher or anyone else wants to learn about PVP, he
should at least talk to people who have it. No one in the
medical establishment has ever contacted me about my PVP,
not once in twenty seven years.
>Have you looked in
> the medical literature?
I am still looking for an honest urologist who cares more
about his patients than he cares about protecting doctors
who are probably guilty of malpractice. And, I am looking
for a way to pay for treatment.
I have found some uros who have done their best to treat my
condition but they will not discuss what was done wrong or
what went wrong. And one of them was honest enough to tell
me why.
Rick
David
It all reminds me of the time when my wife was pregnant the first time. I
was at a consult where she went in determined to have a paticular test
(various reasons) and the consultant had also gone in with the determination
that she should have the test. Both of them went in there ready for a fight
it seems.
As a casual observer, it very quickly became clear that they both had the
same agenda but neither of them realised it. Boy, when they did the sudden
adrenaline loss was spectacular - both of them upon realising they were on
the same side deflated immediately and said nothing for at least a minute!
> I may also post about some legal experiences. Even though
> they are painful, people may be able to learn from my
> mistakes.
That would be helpful. I don't know if personal details are what people
necessarily need - more like the actual legal grounds used as opposed to
personal stuff.
>
> One more point, I have been having some software problems.
> I sent two posts to this group more that 24 hours ago and
> they have not showed up on my news reader. I can tell you
> and anyone else that the remailer network in conjunction
> with the mail to news gateways can be as complicated as
> brain surgery.
>
> I hope that my posts don't start showing up double or worse.
No - just the tree times!
David
www.vasectomy-information.com
trifold
Anonymous...@See.Comment.Header (Rick) wrote in message news:
>
> Your first post to me was the exact opposite of supportive and
> completely off-base. You attributed statements to me that were
> not true and then proceeded to criticize those statements.
Well, I don't think I did this. I certainly didn't mean to, and I'm
sorry if did. In any case, after you said you thought I had, I
immediately replied to explain what I meant to say.
>
> I have provided MANY details in numerous posts to this group in
> the past week. And a three page summary which was also posted,
> thanks to David, to the group website. I am suprised that you
> did not see any of this considering your interest.
Actually, I think I may even have replied to your original post
(although I can't find the thread now). And I have read your story at
the website.
>
> I agree that I am an individual human being and not an overwhelming
> majority. The details that I gave were about my own situation and
> I believe that I made that clear.
Yes. But you have also said you didn't believe any urologist had
studied pvp or treated it seriously because you had not found one.
> You can do whatever you want. I have never told you what to do
> and I have never attacked or criticized you for your beliefs.
> Likewise, I have never put words into your mouth and I never
> criticized you for things that you did not say.
Ummm. . .I guess we can agree to disagree on this point. From my
point of view, you jumped down my throat when I made an observation
about the liklihood of men remaining silent if victimized by pvp, a
statement you chose to interpret as an attack on you, when I only
intended it as a contribution to a discussion you had launched: if
pvp is a big problem, why isn't there more said about it. (As I
recall, I had begun by agree with you.)
>
> Not in my case for the past 27 years which
> includes large quatities of
> of prescibed drugs and two corrective surgeries. Please post the
> names and contact information for any uros who agree with you
> so I can contact them.
I can't give addresses, but I am including below several citations
from medical texts/studies that show pvp is something urologists are
concerned about.
The first is a long excerpt from a standard urology textbook (7th
edition 1998). It lists chronic testicular or epididymal pain as a
known complication of vasectomy. The second citation is perhaps the
most relevant to your case: it describes the role of spermatic cord
denervation (nerve stripping) in treating some forms of pvp. The
studies that follow also suggest medical concern about pvp and ways of
treating it. (There may be other studies at Medline that I have not
included here.)
Finally, for the record, you should know that a couple of years ago,
when David began developing the website, I wrote a piece (still
available at the site) that advises men on issues to raise with their
doctor at the pre-operative consult. One suggestion I had was that
men should ask their doctors about possible complications; AND that
they should ask their doctors how these complications can be treated.
I made the point that if the doctor brushed them off, or had no idea
how to proceed if complications developed, that they should go to
someone else.
trifold
http://www.vasectomy-information.com
********
From:
Walsh: Campbell's Urology, 7th ed., Copyright © 1998 W. B. Saunders
Company
Long-Term Effects of Vasectomy
Long-term effects of vasectomy in humans include vasitis nodosa,
chronic testicular or epididymal pain, alterations in testicular
function, chronic epididymal obstruction, postulated systemic effects
of vasectomy, and possibly, an increased incidence of prostate cancer.
Although vasitis nodosa has been reported in up to 66% of vasectomy
specimens in men undergoing vasectomy reversal (Freund et al, 1989),
this entity does not appear to be associated with pain or significant
medical sequelae.
In humans, micropuncture studies have revealed that the markedly
increased pressures that occur on the testicular side of the vas as
well as the epididymis after vasectomy are not transmitted to the
seminiferous tubules (Johnson and Howards, 1975). Therefore, little
disruption of spermatogenesis is expected in humans. Biopsies up to 15
years after vasectomy show the testes to be essentially normal on
light
microscopy. Electron microscopic studies, however, have revealed
thickening of the basal lamina and scattered areas of disrupted
spermatogenesis in portions of the biopsy specimens (Jarow et al,
1985). Chronic orchialgia or epididymal pain, or both, after vasectomy
occurs in approximately 1 in 2000 patients. In some cases, vasectomy
reversal might be considered or, alternatively, an open-ended
vasectomy
may be used, as described previously. The brunt of pressure-induced
damage after vasectomy falls on the epididymis and efferent ductules.
These structures become markedly distended and then adapt to reabsorb
large volumes of testicular fluid and sperm products. When pain and
tenderness are localized in the epididymis, total epididymovasectomy,
including removal of the testicular vasal remnant, relieves pain in
95%
of men (Selikowitz and Schned, 1985)
and some more:
Complications of Vasectomy
Hematoma and Infection
Hematoma is the most common complication of vasectomy, with an average
incidence of 2% but a range of 0.09% to 29% (Kendrick et al, 1987).
Infection is surprisingly common, with an average rate of 3.4%, but
several series report rates from 12% to 38% (Appell and Evans, 1980;
Randall et al, 1983; Randall et al, 1985). The experience of the
vasectomist is the single most important factor relating to
complications (Kendrick et al, 1987). The hematoma rate was
significantly higher among physicians performing 1 to 10 vasectomies
(4.6%) than among those performing 11 to 50 vasectomies (2.4%) or
greater than 50 vasectomies per year (1.6%). A similar relationship
was
seen for the hospitalization rate.
Sperm Granuloma
Sperm granulomas form when sperm leak from the testicular end of the
vas. Sperm are highly antigenic, and an intense inflammatory reaction
occurs when sperm escape outside the reproductive epithelium. Sperm
granuloma are rarely symptomatic. The presence or absence of a sperm
granuloma at the vasectomy site seems to be of importance in
modulating
the local effects of chronic obstruction on the male reproductive
tract. The sperm granuloma's complex network of epithelialized
channels
provides an additional absorptive surface that helps vent the high
intraluminal pressure in the obstructed excurrent ducts. Numerous
animal studies have correlated the presence or absence of sperm
granuloma at the vasectomy site with the degree of epididymal and
testicular damage. Species that always develop granulomas after
vasectomy have minimal damage to the seminiferous tubules. Some
studies
of men undergoing vasectomy reversal have revealed somewhat higher
success rates in men who have a sperm granuloma at the vasectomy site
(Silber, 1977), whereas another large study has not (Belker et al,
1991).
Although sperm granulomas at the vasectomy site are present
microscopically in 10% to 30% of men undergoing reversal, it is likely
that, given enough time, virtually all men develop sperm granulomas at
the vasectomy site, the epididymis, or the rete testis.
When chronic postvasectomy pain is localized to the granuloma,
excision
and occlusion of the vasa with intraluminal cautery usually relieve
the
pain and prevent recurrence (Schmidt, 1979). On the other hand, men
with postvasectomy congestive epididymitis may be relieved of their
pain by open-ended vasectomy designed to purposefully produce a
pressure-relieving sperm granuloma.
*****
Br J Urol 1997 Feb;79(2):269-70
The incidence of post-vasectomy chronic testicular pain and the role
of nerve stripping (denervation) of the spermatic cord in its
management.
Ahmed I, Rasheed S, White C, Shaikh NA
Airedale General Hospital, Keighley, UK.
OBJECTIVE: To assess the incidence of chronic postvasectomy testicular
pain (CPTP) and evaluate the use of denervation of the spermatic cord
in its management. PATIENTS AND METHODS: A retrospective postal survey
of 560 patients (mean age 36 years, range 25-55; mean time since
vasectomy 19 months, range 8-39) who underwent
vasectomy between July 1992 and December 1994 was carried out to
determine the incidence of CPTP. A prospective study was conducted in
a further group of 17 patients (mean age 43 years, range 34-60), who
had had CPTP for at least one year, to evaluate the effectiveness of
nerve stripping of the spermatic cord in relieving pain. RESULTS: Of
396 replies, 108 (27.2%) patients complained of some testicular pain
following their vasectomy operation. In 88 (82%) of these 108 patients
the pain was brief and was not defined as CPTP, while 20 (19%)
patients had pain for > 3 months; 33 (31%) patients required
analgesics to control the pain. Of the 17 patients who underwent
spermatic cord
denervation, 13 reported complete relief of pain at their first
follow-up visit and were discharged. Four patients had a significant
improvement in the symptom score and were satisfied with the results.
CONCLUSIONS: There is a small but significant incidence of CPTP and
patients should be warned of this possibility when counselled before
operation.
Denervation of the spermatic cord seems to be a viable surgical option
for patients with CPTP who fail to respond to conservative measures.
*******
Br Med J 1982 Jun 5;284(6330):1710
Pain on ejaculation after vasectomy [letter]
Edwards IS, Errey B.
In "Any questions?" (February 6, p. 408) you report a case of a man
with a 2-year history of severe pain on ejaculation starting 2 years
after vasectomy; and Dr. G. Barry Carruthers suggests a diagnosis of
prostatitis, probably unrelated to vasectomy. Pain with ejaculation
following vasectomy is fortunately very rare, but several cases have
been documented. Cures have been reported after excision of a
spermatic granuloma--if one can be
found; or by vasovasostomy for the relief of congestive epididymitis.
We wish to report that in 7 male patients with this distressing
symptom, immediate relief has followed a simple maneuver which can be
carried out under local anesthetic: this is to open the closed lower
end of the vas on the affected side. Spermatozoa arefrom then on
released into and reabsorbed from the scrotal cavity without producing
any symptoms or signs
of their presence there. In none of our cases has this maneuver failed
to produce relief; nor has pain recurred over a period of 1-3 years.
Fertility does not return as the upper closed end of the vas remains
closed. We suggest that others might offer this simple and harmless
procedure to the occasional man unfortunate enough to suffer pain with
ejaculation after his vasectomy.
PMID: 12264227 [PubMed - indexed for
MEDLINE]
*****
Chronic testicular pain following vasectomy
McMahon AJ; Buckley J; Taylor A; Lloyd SN; Deane RF; Kirk D
AUTHOR AFFILIATION: Department of Urology, Western Infirmary,
Glasgow.
SOURCE: Br J Urol 1992 Feb;69(2):188-91
CITATION IDS: PMID: 1537032 UI: 92163801
COMMENT: Comment in: Br J Urol 1992 Sep;70(3):338-9
ABSTRACT: The incidence of chronic testicular pain following vasectomy
has not been previously assessed. We have carried out a survey by
postal questionnaire and telephone interview of 172 patients 4 years
after vasectomy to assess the incidence of chronic testicular pain.
Significant early post-operative complications occurred in 6 patients
(3.5%): 2 infection, 3 haematoma and 1 orchitis. Chronic testicular
discomfort was present in 56 patients (33%), considered by 26 (15%) to
be troublesome but not by the other 30 (17%). Testicular discomfort
related to sexual intercourse occurred in 9 cases (5%). Of the 9
patients who had sought further medical help only 2 had had further
surgery (1 an epididymectomy and 1 excision of a hydrocele). Only 3
patients regretted having had the vasectomy because of chronic pain.
On ultrasound examination, epididymal cysts were a common finding on
both asymptomatic and symptomatic patients following vasectomy. Prior
to vasectomy, all patients should be counseled with regard to the risk
of chronic testicular pain.
*****
TITLE: Epididymectomy for post-vasectomy pain: histological review.
AUTHORS: Chen TF; Ball RY
AUTHOR AFFILIATION: Department of Urology, Addenbrooke's
Hospital, Cambridge.
SOURCE: Br J Urol 1991 Oct;68(4):407-13
ABSTRACT: Fifteen epididymectomies were performed on 10 patients with
post-vasectomy pain and 12 specimens were available for
histopathological review. The findings were compared with those in 2
groups in which epididymectomy was performed for chronic
epididymo-orchitis and epididymal cysts. The results showed that 50%
of the post-vasectomy group were cured by simple epididymectomy.
Pathological findings revealed features of long-standing obstruction
and interstitial and perineuralfibrosis which may have accounted for
the pain. It is important to recognise this late complication of
vasectomy and, if surgery is to be performed, to include all of the
distal vas and previous vasectomy site in the excision.
******
BJU Int 2000 Jun;85(9):1097-9
Epididymectomy is an effective treatment for scrotal pain after
vasectomy.
West AF, Leung HY, Powell PH
Department of Urology, Freeman Hospital, Freeman Road,
Newcastle-upon-Tyne, UK.
OBJECTIVE: To investigate the efficacy of epididymectomy in patients
with significant scrotal pain after vasectomy.
PATIENT AND METHODS: Sixteen patients were identified retrospectively
to have undergone epididymectomy for pain after vasectomy; 19
epididymectomies were performed (three bilateral and 13 unilateral).
Details from the preoperative investigations, histological examination
and follow-up of symptoms were analysed and correlated.
Outcomes were initially assessed at the routine outpatient clinic
review 3 months after surgery and the long-term outcomes were assessed
by a telephone interview 3-8 years after epididymectomy (mean 5.5
years). RESULTS: Of the 16 patients, 14 had excellent initial
symptomatic benefit from epididymectomy. At 3-8 years afterward, nine
of 10
patients interviewed had a sustained improvement of their scrotal
pain. The following were indicators of a poor outcome: atypical
symptoms including testicular or groin pain; erectile dysfunction and
normal appearance of the epididymis on ultrasonography. Patients with
bilateral scrotal pain can have a good outcome after epididymectomy.
CONCLUSION: Epididymectomy in well-selected patients is a reliable
and effective treatment for pain after vasectomy.
******
Urol 2000 Dec;164(6):1939-42
Vasectomy reversal for the post-vasectomy pain syndrome: a clinical
and histological evaluation.
Nangia AK, Myles JL, Thomas AJ JR
Urological Institute and Department of Anatomic Pathology, Cleveland
Clinic Foundation, Cleveland, Ohio.
PURPOSE: The cause of the post-vasectomy pain syndrome is unclear.
Some postulated etiologies include epididymal congestion, tender sperm
granuloma and/or nerve entrapment at the vasectomy site. To our
knowledge nerve proliferation has not been evaluated previously as a
cause of pain. Vasectomy reversal is reportedly successful for
relieving pain in some patients. We report our experience and
correlate histological findings in resected vasal segments with
outcome to explain the mechanism of pain in these patients. MATERIALS
AND METHODS: We retrospectively reviewed the
records of 13 men who underwent vasectomy reversal for the
post-vasectomy pain syndrome. We compared blinded histological
evaluations of the vasal ends excised at vasectomy reversal in these
patients with those of pain-free controls who underwent vasectomy
reversal to reestablish fertility. Controls were matched to patients
for the interval since vasectomy. Histological features were graded
according to the degree of severity of vasitis nodosum, chronic
inflammation and nerve proliferation. RESULTS: Mean time to pain onset
after vasectomy was 2 years. Presenting symptoms included testicular
pain in 9 cases, epididymal pain in 2, pain at ejaculation in 4 and
pain during intercourse in 8. Physical examination demonstrated tender
epididymides in 6 men, full epididymides in 6, a tender vasectomy site
in 4 and a palpable nodule in 4. No patient had testicular tenderness
on palpation. Unilateral and bilateral vasovasostomy was
performed in 3 and 10 of the 13 patients, respectively.
Postoperatively 9 of the 13 men (69%) became completely pain-free.
Mean followup was 1.5 years. We observed no differences in vasectomy
site histological features in patients with the post-vasectomy pain
syndrome and matched controls, and no difference in histological
findings in patients with the post-vasectomy pain syndrome who did and
did not become pain-free postoperatively. CONCLUSIONS: No histological
features aid in identifying a cause of pain or provide prognostic
value for subsequent pain relief. Vasectomy reversal appeared to be
beneficial for relieving pain in the majority of select patients with
the post-vasectomy pain syndrome.
trifold
> I sent two posts to this group more that 24 hours ago and
> they have not showed up on my news reader. I can tell you
> and anyone else that the remailer network in conjunction
> with the mail to news gateways can be as complicated as
> brain surgery.
You may want to consider getting a netscape account (go to
http://www.netscape.com). From that account you can post under any
handle you want, reading and posting from google. (That is what
trifold does.)
trifold
> In article <f6289b53.03031...@posting.google.com>
> trif...@netscape.net (trifold) wrote:
> >
> > Anonymous...@See.Comment.Header (Rick) wrote in message news:
> > >
> > > It is my belief that no one in the medical establishment
> > > has ever looked for people with PVP in order to document
> > > those cases. Because, if there were, I would have found
> > > them.
> >
> > But studies have been done looking for pvp cases.
>
> They could not have looked very far or wide. Can you post
> any advertisements looking for people with PVP or bad
> vasectomy outcomes resulting in serious pain? Do any of
> these researchers have a website?
See below.
>
> If a researcher or anyone else wants to learn about PVP, he
> should at least talk to people who have it. No one in the
> medical establishment has ever contacted me about my PVP,
> not once in twenty seven years.
>
> >Have you looked in
> > the medical literature?
>
> I am still looking for an honest urologist who cares more
> about his patients than he cares about protecting doctors
> who are probably guilty of malpractice. And, I am looking
> for a way to pay for treatment.
>
> I have found some uros who have done their best to treat my
> condition but they will not discuss what was done wrong or
> what went wrong. And one of them was honest enough to tell
> me why.
I post again the citations I posted to your earlier (duplicated)
posting. These suggest the extent to which urologists and others have
been concerned about pvp. The second piece is perhaps most relevant
to your case, as it describes denervation of the spermatic cord as a
remedy for some forms of pvp:
and some more:
******
******
Br Med J 1982 Jun 5;284(6330):1710
Edwards IS, Errey B.
*****
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*******
*****
Rick
Thanks Greenfeather, your posts have helped me to conclude
exactly what went wrong in my case.
Namely, a closed ended V performed by an inexperienced and
sloppy surgeon who hacked through nerves and other tissue.
This situation was made worse by the use of metal clips and
a "hard vasectomy" where the tubes were wrapped with nerves
and could not be seperated by my doctor.(Even though he was
having a problem seperating the tubes, the whole procedure
only took about fifteen minutes.)
I am sure that the outcome would have been completely different
if I had an open end performed by a good surgeon.
My one caveat is that the surgeon should warn the patient of
a greatly increased risk of serious complications if the tubes
are difficult or impossible to seperate from the surrounding
tissue.
Rick
Rick
trif...@netscape.net (trifold) wrote:
> Yes. But you have also said you didn't believe any urologist had
> studied pvp or treated it seriously because you had not found one.
Yes, based on my experience with a good dozen of them who were
interested in covering up and denying bad outcomes and none
that were interested in studying or treating them. I was making
the point that the doctors that you are talking about represent
a tiny minority. I know a lawyer who could not find a single
urologist in an entire state who would examine a bad outcome.
> I can't give addresses, but I am including below several citations
> from medical texts/studies that show pvp is something urologists are
> concerned about.
Some urolgists are and many are not. I have never met one of the
former but have met many of the latter.
> The first is a long excerpt from a standard urology textbook (7th
> edition 1998). It lists chronic testicular or epididymal pain as a
> known complication of vasectomy. The second citation is perhaps the
> most relevant to your case: it describes the role of spermatic cord
> denervation (nerve stripping) in treating some forms of pvp. The
> studies that follow also suggest medical concern about pvp and ways of
> treating it. (There may be other studies at Medline that I have not
> included here.)
Thank you much for this info which I found valuable. It contained
a lot which applied directly to my situation.
> Finally, for the record, you should know that a couple of years ago,
> when David began developing the website, I wrote a piece (still
> available at the site) that advises men on issues to raise with their
> doctor at the pre-operative consult. One suggestion I had was that
> men should ask their doctors about possible complications; AND that
> they should ask their doctors how these complications can be treated.
> I made the point that if the doctor brushed them off, or had no idea
> how to proceed if complications developed, that they should go to
> someone else.
Your suggestions are very good. I only
wish that someone had made them to me.
Rick
Rick
> >
> > The first time that I heard the word "PVP" or "nerve damage"
> > was about one month ago on the internet (this group)
> > in spite of the fact that I have suffered from it for twenty
> > seven years, have seen many doctors, and have been hospitalized
> > for it twice.
>
> I am sorry for your experience.
Thank you for your support.
> Perhaps you should tell us more about
> it, so men who want vasectomies can avoid the problems you have
> experienced.
Yes. I have already posted much information about my problems
and I will continue because I do have more to say which may
help others to avoid problems.
>I hope you will not consider the following comment
> hostile,
Your first post to me was the exact opposite of supportive and
completely off-base. You attributed statements to me that were
not true and then proceeded to criticize those statements.
>but I do need to say that one reason details of your
> situation will be helpful is that your situation is so extremely rare:
I have provided MANY details in numerous posts to this group in
the past week. And a three page summary which was also posted,
thanks to David, to the group website. I am suprised that you
did not see any of this considering your interest.
> all evidence suggests the overwhelming majority of men don't suffer
> problems like yours after vasectomy.
I agree that I am an individual human being and not an overwhelming
majority. The details that I gave were about my own situation and
I believe that I made that clear.
>This leads me to believe
> something about your case is special, and by knowing more about your
> case, other men can take steps to avoid your bad outcome.
Yes. I agree that this is very important and I do have more to
say about this. In fact, I finally have a good understanding of
what went wrong.
>Which kind
> of vasectomy did you have? How soon after the vasectomy did your pain
> develop? What remedies have been attempted?
I have answered all these questions in my previous posts.
>In the meantime, I will
> continue to advise men vasectomy is safe and effective, pointing to
> the medical evidence: 1) that complications are very rare;
You can do whatever you want. I have never told you what to do
and I have never attacked or criticized you for your beliefs.
Likewise, I have never put words into your mouth and I never
criticized you for things that you did not say.
>2) that
> there are effective treatments for these complications when they
> occur.
Not in my case for the past 27 years.
Rick
Rick
> >
> > It is my belief that no one in the medical establishment
> > has ever looked for people with PVP in order to document
> > those cases. Because, if there were, I would have found
> > them.
>
> But studies have been done looking for pvp cases.
Where did they look? I have had two corrective surgeries
performed at a major university hospital in a major city.
More than two dozen doctors and a major medical society
know of my PVP. I have been looking for help everywhere
and have never seen any advertisement or heard of anyone
looking for PVP. And I have never been asked to participate
in any study.
My opinions are based on more than two decades of personal
experience with this issue. It is not based on something that
I read in a book. In fact, I could write a book about it.
If a researcher or anyone else wants to learn about PVP, he
should at least talk to people who have it. No one in the
medical establishment has ever contacted me about my PVP,
not once in twenty seven years.
>Have you looked in
> the medical literature?
I am still looking for an honest urologist who cares more
about his patients than he cares about protecting doctors
who may be guilty of malpractice. And, I am looking for a
way to pay for the exspensive treatment that I need as a
result of doctors covering up bad outcomes and malpractice.
I have found some uros who have done their best to treat my
condition but they will not discuss what was done wrong or
what went wrong. And one of them was honest enough to tell
me why.
Rick