Nevada shooting update: Experts question surgery link

There is no evidence that vasectomy leads to significant health problems, making it unlikely that the Urology Nevada patient who took the life of one urologist and injured another was suffering from the effects of “botched” surgery, say two urologists who are experts in vasectomy.

However, as with any surgical procedure, vasectomy has potential complications that patients should be made aware of, Jay Sandlow, MD, and Stanton Honig, MD, who served on the panel that developed the AUA’s 2012 guidelines on vasectomy, told Urology Times.

Reno-based Urology Nevada also said that, after reviewing the care provided to patient Alan Frazier, 51, the practice found “no basis” to support Frazier’s allegations that his vasectomy led to serious long-term complications, which may have prompted his actions.

On Dec. 17, 2013, Frazier shot and killed urologist Charles G. Gholdoian, MD, and wounded Christine N. Lajeunesse, MD, another urologist at the practice, along with Shawntae Spears, a 20-year-old relative of a patient. Frazier then committed suicide. A friend of Frazier’s had told the Reno Gazette-Journalthat complications from Frazier’s vasectomy had left him “so sick and weak that he could barely move,” the newspaper reported.

According to Dr. Sandlow, short- and long-term complications of vasectomy include bleeding, infection, chronic testicular pain, and failure of the procedure.

“However, based on the literature, the incidence of these complications is approximately 1% to 2% and the failure rate is approximately 1:2,000 (when sterility has been confirmed),” said Dr. Sandlow, of the Medical College of Wisconsin, Milwaukee.

“While preparing the AUA guidelines on vasectomy, we reviewed all of the literature regarding short- and long-term impact on health after vasectomy. We found no evidence that vasectomy leads to significant health problems,” Dr. Sandlow said.

The guidelines state that “Chronic scrotal pain associated with negative impact on quality of life occurs after vasectomy in about 1-2% of men. Few of these men require additional surgery.” Dr. Honig pointed out that the unabridged guideline also states: “Medical or surgical therapy is usually, but not always effective in improving this chronic pain.”

“How a patient perceives the effects of chronic scrotal pain on his general health is highly individualized,” said Dr. Honig, of Yale-New Haven Hospital, New Haven, CT. “There is no clear published data to suggest that vasectomy has a negative effect on sexual or psychological function. However, individuals do report these complaints, as most of us see these patients in the office in follow-up.

“Overall, patient selection is very important, and good judgment is always recommended when evaluating a patient for a vasectomy,” Dr. Honig said.

Drs. Honig and Sandlow also wrote the chapter on contraception for “Infertility in the Male.”

In an open letter on its website, Urology Nevada said its practitioners “find no basis to support any of the allegations made by [Frazier] regarding his care or treatment. We can neither understand nor explain his senseless and horrible actions.”

“We thank all of you who have stood beside us during this difficult time. Our thoughts and prayers remain with the family of the friend and colleague we lost,” the letter read. “We offer our best wishes for a speedy and full recovery to those who were injured.”

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