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Complications of Benign Adult Penile and Scrotal Surgery
Published in Kevin R. Loughlin, Complications of Urologic Surgery and Practice, 2007
Jeffrey C. La Rochelle, Laurence A. Levine
Chronic pain after vasectomy, also called postvasectomy pain syndrome (PVPS), can be unilateral or bilateral and is often described as a dull ache or sharp pain that worsens with ejaculation or physical exertion. The cause of the pain is not known precisely, but many researchers suspect congestive changes in the epididymis to be the source (90,97–99). Sperm granulomas from leakage of spermatozoa from the vas or epididymis have also been blamed for the symptoms (100), but pain from these lesions appears to be the exception rather than the rule (90,99,101). In fact, a sperm granuloma resulting from leakage from the epididymis (epididymal blow-out) may be protective for PVPS because pressure in the epididymis has been vented, thereby alleviating congestion that might otherwise cause chronic pain (90,99). Moss advocated the use of open-ended vasectomies where the abdominal end is closed and the testicular end of the vas is left open to prevent congestion of the epididymis (101). In a series of over 6000 patients, he found congestive epididymitis in 6% of men with closed-end vasectomies and 2% of those with the open-end technique. Shapiro and Silber also compared open- and closed-end vasectomies in 800 patients (90). Sperm granulomas formed in 97% of men with the open-end method, and none of them were painful. They found a 4% recanalization rate with the open-end technique when the abdominal end was only cauterized, and the failure rate fell to 0.4% when the abdominal end was clipped.
Urologie Pain
Published in Mark V. Boswell, B. Eliot Cole, Weiner's Pain Management, 2005
Hossein Sadeghi-Nejad, Carin V. Hopps, Allen D. Seftel
The pathophysiology of this condition is not entirely known, but tender sperm granuloma, nerve entrapment, or nerve proliferation at the site of vasectomy, perineural fibrosis, and mechanical duct obstruction with epididymal congestion have been suggested as possible causes (Nangia et al., 2000; Sweeney, Tan, Butler, McDermott, Grainger, & Thornhill, 1998). Epididymal engorgement, complex cystic disease, and chronic epididymitis are the main histological findings in post-vasectomy patients with scrotal pain (West et al., 2000). Other investigators, however, have observed no differences in vasectomy site histological features in patients with the post-vasectomy pain syndrome and matched controls, and no difference in histological findings in patients with the post-vasectomy pain syndrome who did and did not become pain-free postoperatively (after microsurgical vasectomy reversal) (Nangia et al., 2000).
Non-pharmacological treatments for chronic orchialgia: A systemic review
Published in Arab Journal of Urology, 2021
Kareim Khalafalla, Mohamed Arafa, Haitham Elbardisi, Ahmad Majzoub
A distinct subset of patients with CO are those who develop their symptoms following a vasectomy procedure for elective sterilisation. Chronic pain following this procedure, termed PVPS, has been identified as a late complication occurring in up to 15% of cases [51]. It is defined as intermittent or constant scrotal pain that occurs after a vasectomy procedure and stays for >3 months. The pain is typically aggravated with ejaculation, physical activity, and with pressure over the testis. Conservative measures of treatment can be tried first; however, if the pain persists for a long duration and affects the patients’ daily activities, then a vasectomy reversal procedure should be considered. A total of five studies including 131 patients who underwent vasectomy reversal due to PVPS were identified [36–40]. Overall, the reported improvement in pain after surgery was 69–93%. Lee et al. [38] linked pain improvement with the patency rates after surgery. In all, 22 patients who underwent vasectomy reversal for PVPS completed a study questionnaire and were assessed with a VAS pain score before and after the operation. The patency rate was 68.2% and the pain reduction was significantly more meaningful in the patent group, with a VAS mean (SD) difference of 6.0 (1.25) vs 4.43 (0.98) in the non-patent group (P = 0.014). This result highlights the relationship between vasectomy and the development of pain after the procedure and hints that an obstructive pathophysiology is the most likely mechanism for PVPS.
Post vasectomy chronic pain: are we under diagnosing vasitis? A case report and review of the literature
Published in The Aging Male, 2020
Adam Jones, Mahmood Vazirian-Zadeh, Yih Chyn Phan, Wasim Mahmalji
What is unique to this case is that the patient had a reversal of vasectomy and subsequent re-do vasectomy. To our best knowledge, no previous case reports of acute vasitis have had a vasectomy. Vasectomy is one of the most common urological procedures performed, there are around 500,000 performed in the United States each year [5], Trinick et al. [6] reported rates of vasectomy at 34% in patients in their 60s. It is the most effective male contraceptive method and has a success rate of 98% [7]. The procedure is typically performed under local anaesthesia and involves excision of at least 1 cm of the vas deferens. Electrocautery fulguration to the remaining ends of the vas deferens, or placement of sutures, is a technique used to prevent recanalization [5]. Complications associated with vasectomy include infection, symptomatic hematoma, vasectomy failure and post-vasectomy pain syndrome (PVPS) [8].