PERSONAL VIEW Review of the complications and medicolegal implications of vasectomy

The operation of vasectomy is a commonly performed procedure for male sterilisation. It should normally be a straightforward day case procedure undertaken by a competent medical practitioner under local anaesthesia. But how is competence assessed? General practitioners (GPs) have increasingly undertaken minor surgical procedures, and guidance to ensure an appropriate standard of care for patients undergoing such surgery in general practice has been published. Vasectomy, however, is not specifically mentioned though problems relating to vasectomy are the main cause of claims against GPs for medical negligence related to minor surgery. Litigation against secondary care practitioners, mainly urologists and general surgeons undertaking vasectomy in the hospital setting or in private practice, is also highly prevalent. Neither the Royal College of Surgeons of England nor the Joint Committee for Higher Training in Urology mentions vasectomy in their curricula. The most common reason for complaint is that the operation failed to render the patient sterile, but failure to warn patients of possible complications such as pain, haematoma, and infection are also prominent causes of patient dissatisfaction. In this article we outline the potential pitfalls in oVering a vasectomy service and suggest ways of avoiding them. In so doing we aim to provide guidance for best clinical practice in this litigious area.