This page examines the page entitled "Important medical quotes".

Quote

Analysis

1. Epididymectomy for post-vasectomy pain: histological review. Chen TF, Ball RY. Br J Urol. 1991 Oct;68(4):407-13.

The words are not actually altered beyond adding the definition of fibrosis. However, the context is. The study was into the effectiveness of epididymectomy as a cure for post vasectomy pain, and not incidence of post vasectomy pain as implied. The study group consisted of 10 men with post vasectomy pain, and 14 nonvasectomised men with other urological conditions being the cause of the pain. The results discuss the effect on the study group as a whole. Remember that all of the men in the vasectomy group were in the study because they had the problem - it isn't a study into the incidence rate as implied. A study into clinical pathologies of a selected group, and effectiveness of a particular treatment is NOT a study into incidence rates.

2. Complications of vasectomy. Raspa RF. Am Fam Physician. 1993 Nov 15;48(7):1264-8.

This study discusses vasectomy complications, and advises family physicians that they should counsel patients appropriately. There is a sentence that states a list of complications reputed to be associated with vasectomy, and the second half of the sentence has been deleted. The second half of the sentence says "although not substantiated by clinical studies". The original context is a list of reputed to have an association that have NOT been proven by clinical studies. His context by deleting the second half of the sentence is that they have.

He's also chosen to remove the summary sentence of "Compared with tubal ligation, vasectomy has fewer serious complications and a comparable failure rate. " again, altering the context.

3. Chronic testicular pain following vasectomy. McMahon AJ, Buckley J, Taylor A, Lloyd SN, Deane RF, Kirk D. Br J Urol. 1992 Feb;69(2):188-91.

This study was a questionnaire study with 172 participants, and HUGE chunks have been deleted!

The study has been taken out of context by only using part of one sentence of the results. There are too many deletions to list. The author actually only uses part of one sentence that claims 33% discomfort rate, and the summary that all men should be informed of the possible risk of pain after vasectomy. I use the word "Discomfort" throughout, as that is the word used by study authors. A summary of the deleted statistics is below.

• Early complications such as infection, hematoma and orchitis (swelling) applied to 6 out of 172 patients (3.5%).

  Of the 56 patients that answered yes to the pain question, 30 of them (54%) did not consider the discomfort troublesome.

  9 patients out of 172 (5%) complained of testicular discomfort related to sexual intercourse.

  9 patients (5% - and not necessarily the same 9 above) sought medical help for problems.

  2 patients (1%) required surgical intervention for epididymectomy and 1 excision of a hydrocele.

  3 patients (1.7%) regretted vasectomy because of pain.

So this study raises more questions than answers. The number of men in the survey who claimed to have discomfort (remember, the study asked about discomfort NOT pain) is small (56), and therefore likely to produce statistically strange numbers. Larger study sizes are required to produce results that are consistent and believable.

4. Schwingl PJ, Guess HA, Safety and effectiveness of vasectomy. Fertility and Sterility, 73: 5, 923-36, May, 2000.

An entire peer review document consisting of 139 carefully analysed studies condensed into one sentence!!!

"Future studies should include evaluations of the long-term effectiveness of vasectomy, evaluating criteria for post-vasectomy discontinuation of alternative contraception for use in settings where semen analysis is not practical, and characterizing complications including chronic epididymal pain syndrome."

The quote above does not actually appear in the document - he's borrowed half of one sentence from page 1, and half of a sentence from page 12 to make one sentence!

The purpose of the study was to analyse the results of existing studies and to make recommendations for future research. It's not a document about post-vasectomy pain, but being a comprehensive peer review it has a section on the topic. The section discusses the research available, and points out the different methodologies and wide variety of results making it difficult to form any conclusions.

The summary of the paper says that "Long-term effectiveness studies with high follow-up rates are needed to document long-term failure rates of vasectomy for different methods of vas occlusion, use of fascial interposition, or importance of the length of the vas removed. In addition, these studies should characterize the incidence of long-term complications such as chronic epididymal pain syndrome". They are saying that future studies into effectiveness of various procedures should use post vasectomy pain as one of the measurements of effectiveness - NOT that the studies should be ABOUT pain. Although there is implication within the whole of the document that further research into pain should be considered.

5. 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. Br J Urol. 1997 Feb;79(2):269-70.

Again, a single sentence from the entire study text. The study was a clinical one into the use of microsurgical denervation as a cure for post vasectomy pain. It recruited 17 men, and reports that denervation worked well in 13 men. The sentence quoted is merely part of the summary.

6. Questionnaire-based outcomes study of nononcological post-vasectomy complications. Choe JM, Kirkemo AK. J Urol. 1996 Apr;155(4):1284-6.

This particular quotations is interesting because virtually none of the wording on dontfixit.org's page is in the version from the National Library of Medicine. The first sentence of his version is compiled from the original wording, and isn't particularly out of context, but yet again he's made up his own sentences and added them. The following sentence from his version DOES NOT appear in the original:-

"A review of the literature would suggest that techniques in which the epididymal vas is not ligated can reduce the incidence of post-vasectomy scrotal pain. Regardless of the technique used, the high litigation potential of this procedure warrants thorough counseling of the factors that may affect quality of life."

The results of this particular survey suffer heavily from detection bias. It was in the form of a postal questionnaire to 470 patients, and only 182 responded. A response rate of 39%. As the questions were on the subject of pain, many of those who didn't have problems may not have responded, leaving mainly those who had some form of complications as the survey's respondents. Only 4 men had pain which adversely affected the quality of life - 0.85% of the total survey and 2% of the respondents.

7. A long-term follow-up of 108 vasectomized men. Good counselling routines are important. Ehn BE, Liljestrand J. Scand J Urol Nephrol. 1995 Dec;29(4):477-81.

Again, one sentence from an entire report completely taken out of context.

The study looked at how successful counselling was amongst vasectomy candidates at local clinics, and followed up at 2 and 7 years. Of the men who received counselling, 95% of the men reported being satisfied with the procedure 7 years later. The surveys had a response rates of virtually 100% in both of the follow up's.

8. Individuals web page.

Not a medical page, but an individuals personal web page associated with dontfixit.org containing quotes from various other web pages and a few links to similar pages elsewhere.

9. A comparison of open-end versus closed-end vasectomies: a report on 6220 cases. Moss WM. Contraception. 1992 Dec;46(6):521-5

Another case of selective quotation and adding words to change the context. The study does not have the words "a synonym for post-vasectomy pain syndrome" in respect of congestive epididymitis. Congestive epididymitis is a common urological complaint - NOT post vasectomy pain syndrome!

The purpose of the study was to compare differences between men having the open ended vasectomy procedure and standard vasectomy performed by one surgeon.

10. Vasectomy reversal for treatment of the post-vasectomy pain syndrome. Myers SA, Mershon CE, Fuchs EF. J Urol. 1997 Feb;157(2):518-20

This is the best one yet! Absolutely all of it is made up! The only exception is the very last sentence, and that's been re-worded!

The first line of the study says "The post-vasectomy pain syndrome is a rare but troublesome complication of vasectomy." It makes an appearance as the summary line, with the word troublesome changed to serious. The rest of the quotation DOES NOT appear in the original. It's all made up and added by the author of dontfixit.org.

Just for the record, the study looks at 32 men with post vasectomy pain syndrome, and the success of different versions of the vasectomy reversal procedure in managing the condition.

11. Vasectomy: an appraisal for the obstetrician-gynecologist. Peterson HB, Huber DH, Belker AM. bstet Gynecol. 1990 Sep;76(3 Pt 2):568-72.

Another solitary sentence taken completely out of context. The study is an appraisal of vasectomy for the obstetrician-gynecologist, and discusses the effectiveness and health risks for the purpose of counselling female patients on both male and female sterilisation. It states that Vasectomy represents a safe and effective alternative to tubal sterilization for couples who decide that the male should be sterilized. The original context of the sentence as quoted by dontfixit.org is simply a warning that like female sterilisation, vasectomy should not be considered reversible.

12. Spermatic granuloma: an often painful lesion. Schmidt SS. Fertil Steril. 1979 Feb;31(2):178-81.

Wow - hang out the flags! This quote is 100% correct! The study puts the rate at 54%. In fact, this is lower than many studies. Most studies put the incidence of spermatic granuloma at about 60% with most being asymptomatic - the patient is unaware of them. The incidence of granulomas requiring intervention in this particular study is very high. Most studies put it at near 2% - 3%.

13. A late post-vasectomy syndrome.Selikowitz SM, Schned AR. J Urol. 1985 Sep;134(3):494-7.

Oh dear - more fiction! As with study 10 (above), virtually all of the quoted abstract is made up, and does not appear in the National Library of Medicine original.

The words "Patient discomfort usually was constant, often disabling, exacerbated by sexual activity and, occasionally, radiating along the spermatic cord structures…. because the vasectomy procedure is so prone to medico-legal complications, we believe that the late post-vasectomy syndrome should be included in the informed consent form for vasectomy." DO NOT appear in the original and have been added by the author of dontfixit.org.

For the record, the study looked at 20 pathological samples of 18 men who had an epididymectomy for relief from post vasectomy pain syndrome. The samples revealed features consistent with sequelae of long-standing obstruction. The authors do not state if these were pre-existing before the vasectomy, or more recent.

14. Van Der Poel, HG, Meuleman, EJ, Post-vasectomy pain, an underestimated side-effect. Online article that has been a dead link for some years.

Obviously the quote has a sentence from the top of the page, and a sentence from the bottom presented as a quote. I think we take this technique of quoting as the norm now! In fact, the quote from dontfixit.org is a quote of a quote of a quote! I'm not entirely sure of the accuracy.

I do have a copy of this article that I saved from when it was online. It's interesting not from the point of view of what it says, but what has been said about it! Basically, it's a literature review by two Dutch researchers looking at various vasectomy research available at the time. US based studies were used by the researchers. They then calculated the number of Dutchmen that could be possibly affected by ctp if the results of one of the American studies was applied to the male population of the Netherlands. They made no attempt to convince people that it was anything other than a mathematical extrapolation, but the rest of the world from that point came to regard it as an actual study! Dontfixit.org and others have pointed to "The Dutch Study", "New research from the Netherlands" etc. and it's now an urban myth. Like other urban myths it's not true - it's not a real study!

For the record, the quote of the quote of the quote is originally attributed to Vasectomy and health. Results from a large cohort study, Massey et all 1984. It looked at 10,590 men from four cities who had had a vasectomy, and paired them with 2318 pairs. The summary of the study is "Results of this study do not support the suggestions of immunopathological consequences of vasectomy within the period of follow-up. Except for epididymitis-orchitis, the incidence of diseases for vasectomized men was similar or lower than for their paired controls." Now I wonder why dontfixit.org didn't publish that bit of the study!

15. Immunological consequences of vasectomy. Shahani SK, Hattikudur NS. 1: Arch Androl. 1981 Sep;7(2):193-9

The actual quote is (unusually) actually accurate, but the words surrounding the quote change the context of the quote. I think the difficulty is that the National Library of Medicine has two versions - a short and long abstract. Hauber quotes the short abstract. The long abstract start with the sentence "Vasectomy leads to auto-immune pathology in more than 50% of men. The immunological changes, if any, following vasectomy......."

16. Open-ended vasectomy, sperm granuloma, and postvasectomy orchialgia.Shapiro EI, Silber SJ. Fertil Steril. 1979 Nov;32(5):546-50.

Removing the vast majority of the study changes the context. The study looks at the role of the granuloma in the open ended procedure, and uses previously published research along with it's own sample of 9 patients referred for treatment in the form of vasectomy reversal. The study said that the risk of orchialga was very small. As the Hauber version doesn't delete this fact, it's difficult to see what point the extract proves apart from making up the numbers of studies he refers to.

17. An online quote from Dr. Malcolm Carruthers, MD, Vasectomy - The Unkindest Cut of All.

Firstly Dr. Carruthers is no longer a doctor. He was struck off the medical register by the General medical Council in 2002 for prescribing testosterone replacement therapy products online against the guideline and previous warnings given by the GMC.

The web page listed left is no longer available, but the site is. It's a clinic that offers testosterone replacement therapy, and publicises Carruthers' book.

18. Hall, Michael, What You Never Heard About Vasectomy, [Online].

This is simply a anti-vasectomy whine presented as a medical paper and put online claiming to be one. I guess it's included in the "Statements from doctors and researchers" section on the grounds that anyone who wants to whine for a long time about something could be termed a researcher in an extremely loose usage of the word.

19. Vasectomy is associated with an increased risk for urolithiasis. Kronmal RA, Krieger JN, Coxon V, Wortley P, Thompson L, Sherrard DJ. Am J Kidney Dis. 1997 Feb;29(2):207-13

Although the study did find an increase in kidney stones, the entire text as quoted by Hauber is completely made up and does not appear in the original.

20. Analyses of indications for and outcomes of epididymectomy. J Urol. 1996 Jul;156(1):95-6.

This study is interesting in that there is no mention of vasectomy anywhere in the study! It assesses the outcomes of epididymectomy on patients with CTP - a common urological complaint. Yet the author attaches the statement "Chronic intrascrotal pain may occur in up to a third of patients after vasectomy and in approximately half the pain is considered troublesome." to the study. The study simply never said anything like that, and is not about vasectomy anyway! It's a quote stolen from study 3 (above) and reworded. Study 3 is about DISCOMFORT - not pain.

21. An quote from Dr. Malcolm Carruthers, Maximizing Manhood: Beating the Male Menopause.

As in 17, it should be pointed out that Carruthers is no longer a doctor, having been struck off the medical register by the GMC in 2002 for prescribing testosterone replacement therapy products online against the guideline and previous warnings given by the GMC.

22. Same as study 16.

This quote is attributed to study 16 above. The following text is attributed to the study, but as can be seen by clicking link 16 at the bottom of the page absolutely none of the quote below appears in the study!!!

"When a patient elects to have a vasectomy, he must understand that pressure build-up proximal to the vasectomy site, congestion of the epididymis, and, indeed, epididymal blowouts are inevitable consequences of this surgical procedure. In more than 800 vasovasostomy patients whom we have seen, there is always some degree of epididymal engorgement and congestion. Indeed, after one explores these postvasectomy patients microsurgically, it becomes difficult to understand why the vast majority of such patients have no pain or discomfort."

23. Same as study 2.

As per study 16, a check on the original by clicking link 2 reveals that absolutely none of the quote below appears in the study.

The greatest anatomic effects of vasectomy occur in the rete testis, epididymis and vas deferens. The rete testis and epididymis frequently sustain damage induced by back-up pressure. Blow-outs and secondary sperm extravasation commonly occur at the body and tail of the epididymis. Vasectomy usually causes loss of tone and luminal dilation of the testicular end of the cut vas deferens…. Antisperm antibodies can be measured in the serum of up to 70 percent of men after vasectomy…."

24. Vasectomy and health. Results from a large cohort study. Massey et all. JAMA. 1984 Aug 24-31;252(8):1023-9

The Hauber version:- "Men with antisperm antibodies may be at risk for the development of immunologically mediated diseases. Furthermore, immune complex orchitis, glomerulonephritis, and exacerbated atherosclerosis have been demonstrated in vasectomized animals…. It was reasoned that such antibodies, or possibly immune complexes containing such antibodies and sperm antigens, might cause disease, either locally in the testis or epididymis, or in the organs remote from the operative site…. As expected there was a notable excess of epididymitis-orchitis in the vasectomized men…."

The REAL version:- "Results of this study do not support the suggestions of immunopathological consequences of vasectomy within the period of follow-up. Except for epididymitis-orchitis, the incidence of diseases for vasectomized men was similar or lower than for their paired controls."

You've probably got the message by now that the quote above does not appear in the original.