The study by Dr Alderman1 in this issue concerns the operation most commonly performed on adult men, elective vasectomy for family planning. The author, using the most popular technique of vasectomy (ie, cutting the vas deferens, excising a segment, and ligating the cut ends), reports 97 failures among 5331 men who were available for follow-up. In some of these failures the semen was never clear of sperm; in others sperm reappeared, sometimes several years after initial negative testing. These findings document the fact that the patient can eliminate the sperm from the urethral side of the vas deferens only to have the ducts rejoin later. This should be of deep concern to both the patient and his surgeon. Both need to know when sterility can be considered permanent. An operation with an uncertain result is not a good operation.
See also p 3142.
Consent to perform surgery is a