Recommend a urologist that more doctor than mechanic.
September 17, 2017 11:22 PM   Subscribe

I would like a recommendation for a urologist in the Boston area that: 1) Can do a vasectomy. 2) Can intelligently explain the risks of various complications and what they would do to mitigate them.

I previously had a consultation with a urologist referred to me by my primary care provider.

It was mostly conducted by a nurse practitioner who told me that I should know that about a possible complication. However, neither they nor the doctor were able to point me to resources explaining what the chances of this happening were. In fact, they were annoyed that I asked. The doctor simply replied, "Don't worry about it."

Moving on from the chances, I asked about remedies for that complication. The doctor's answer was basically, eh, aspirin or something.

Perhaps all urologists are not fond of explaining procedures, but even then, I think we can do better than this. If you'd like to tip off anonymously about good urologists, email!
posted by anonymous to Health & Fitness (3 answers total)
I had my vasectomy at Metrowest Urology in Natick about two weeks ago. Similar to your experience, I was counseled by a nurse practitioner for the initial appointment. I did not even meet the doctor until he was betadyning my balls. Nice guy though!

Two mutually inconsistent observations:

First, I don't know what complications you're concerned about (continued fertility? Impotence? MRSA?), but a vasectomy is a commodity procedure performed with topical anesthetic in 15-20 minutes on an outpatient basis. My guy had done, by his estimation, 40,000 vasectomies. The steps he takes to mitigate the risk of an adverse result is that he's done more vasectomies than I've had hot meals in my life. Doctors are not going to tell you that they've "reduced the risk of impotence from the 0.5% commonly accepted as standard to 0.2% by using advanced alien technology." They avoid the bad result by having done this 40,000 times. It's like asking your pilot what steps she's going to take to avoid a crashing into a mountainside. The doc is there to hold your balls, not your hand.

Second, and somewhat contradictory to the first point, I was told you can cut the vas deferens closer to the testicle or closer to the urethra. The guy at Metrowest Urology (whose name I've honestly forgotten) cuts closer to the urethra, and cauterizes the loose end, which he thinks leads to better results. I didn't shop around, though, so I can't vouch for whether that's either novel or true.

I can say I experienced only momentary discomfort during the procedure as he fished my vasa deferentia (hat tip to Google for the cumbersome plural) out of my scrotum to do the snip (more so on the far side, as he had to fish it over to the near side incision he had made). I did not have much tenderness at all afterwards. I iced the area idly for a few hours and took a Tylenol. I took another Tylenol the next day, but didn't bother to ice it, and had neighbors over for breakfast and visited with friends that afternoon. My wife, who had had a C-section, tried to pamper me, but it was ridiculous to do so. Getting a plantar wart removed was more painful, to say nothing of what she endured in delivery. The small incision is still healing; it was well enough for a wank within 72 hours, but I'll give it a couple more days before tying sex.

In short, thumbs up for Dr. whoever, and one vote (as a patient and not a doctor) for this not being a big deal to fret about. Good luck, and enjoy shooting blanks.
posted by 5845(f)(1)(D) at 6:15 AM on September 18, 2017 [2 favorites]

My vasectory 20 years ago was quite similar to 5845(f)(1)(D)'s. Because I was under 25 and had had no kids the doc did briefly (~2-3 minutes) meet with me so he could get a feel as to how much I knew about / wanted the procedure, and then he left and the nurse practitioner went over the process with me. My doc had "only" done about 2,500 vasectomies.

I love making burritos, and I doubt I've made 1000 in my lifetime. 2,500 - 40,000 is a lot of practice doing something.

It's an extremely super routine thing that if they're spending an extra 10-20 minutes per patient, then it pretty much halves the number they can do. You're sadly, much better off trying to educate yourself over something like this. I'd say personally knowing how routine this is, I would not want to have this done by someone who's done less than 1,000 . Yeah, they've got to get the practice somehow, but I guess I'd by NIMBY about this in retrospect.

That said, the one complication that I'm now aware of (and wasn't aware of before) that I wish that I'd known (and known the percentage who are affected) is some small percentage of men will experience chronic pain in that area. Possibly a result of a nerve taking the cauterization badly. I think the only thing that might help is to try a recut, and perhaps different closing technique. Fortunately for me, like most, is there's been no issues. And realistically if I'd known and the odds were likely below 10-15% for the chronic pain I'd still likely have gone forward with the vasectomy.

There are some studies that indicate there might be a slight elevatated correlation of vasectomies with later low-intermediate-grade prostate cancer prostate cancer. But there's other studies which find no evidence for this.
posted by nobeagle at 7:06 AM on September 18, 2017 [1 favorite]

Dr. Michael Curran has been doing this for a good long time, and lately has been speaking about prostate cancer -- so he probably can address your concerns quite well:

That said, he's now out of hospitals and into a private, speciality practice (just down in Dedham) which may now also have an NP out running interference on the initial appointments. When you call, you could just ask whether you'll get to meet him beforehand. *shrug*

Also, he wore a Notre Dame skullcap during the procedure, which as a B.C. grad was a little off-putting. But at least the building's power didn't go out until after the procedure ended, which was concerning but could have been so much worse!
posted by wenestvedt at 10:49 AM on September 18, 2017

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