Most men who undergo vasectomy have no difficulties, but a small group of men develop chronic testicular or epididymal pain after the procedure. This pain can start immediately after surgery and is usually due to a sperm granuloma (inflammation at the vasectomy site) or infection and most cases resolve with the appropriate medical therapy. Occasionally, chronic pain may develop after the vasectomy and be exacerbated by ejaculation. This pain is thought to be the result of back pressure building up in the epididymis and is known as “post vasectomy pain syndrome”. Most doctors who perform vasectomy are unaware of this condition and don’t offer appropriate treatments. Some even tell patients that the pain is “in their head” and they should just learn to deal with it. Other doctors refer patients to pain management clinics who can only offer temporary solutions. Groin or spermatic cord blocks rarely provide more than a few hours of relief.
While it must be stressed that these are fairly uncommon occurrences after vasectomy, they are frustrating and difficult to deal, with for both the patient, and the physician. We offer a range of treatments for these syndromes including non surgical treatments, vasectomy reversal, open-ended vasectomy, microsurgical denervation of the spermatic cord and chemical sterilization. Most patients with this problem, which has been ignored for so long, need not suffer. Dr. Werthman has treated many men with post-vasectomy pain syndrome and has emerged as a World’s leading authority on the subject. He has written a section on this in the medical textbook “Complications of Urologic Surgery” and has compiled research on the treatment. Below is a study conducted at CMRM that was presented at the American Urological Association’s 2010 meeting.
VASECTOMY REVERSAL FOR POST-VASECTOMY PAIN SYNDROME: A TEN-YEAR EXPERIENCE. Philip Werthman, Los Angeles CA
INTRODUCTION AND OBJECTIVE: Post-vasectomy pain syndrome is a nebulous term for chronic and sometimes debilitating scrotal pain following vasectomy. The syndrome and treatments have been poorly characterized. We report on a single surgeon’s 10-year experience treating patients with vasectomy reversal for chronic post-vasectomy pain.
METHODS: We reviewed the charts of 45 men (vasectomized elsewhere) who presented with the complaint of chronic pain after their vasectomy. Data was collected as to time of onset of pain, years since the vasectomy, prior treatments, nature and quality of the pain, physical findings, surgical findings and outcomes of vasectomy reversal and requirement for additional treatment.
RESULTS: 45 men were evaluated for post-vasectomy pain. 63% stated their pain began during the vasectomy, 8% within the first week thereafter, 13% within the first 5 months and remainder within six years. Median age of the vasectomy was 3.7 years with a range on 0.4-18 years. Twenty patients (45%) complained of pain after ejaculation, 45% complained of a dull testicular ache, 15 % had sharp and burning pain radiating up to their abdomen, and 10% complained of a tender lump. Two patients complained of constitutional symptoms. Sixty-seven percent of patients were initially treated by their local urologist with antibiotics and anti-inflammatory drugs and had no response. Two patients had excision of sperm granulomas with conversion to open ended vasectomy and 2 patients had failed vas reversals. Seventy percent of patients elected to undergo a microsurgical vasectomy reversal with excision of the vasectomy scar/granuloma. At the time of surgery, 40% were found to have a sperm granuloma, 15% had generalized inflammation around the vas, 29% had no unusual post-vas findings and one patient had large neuromas. Seventy-five percent of reversal patient’s experienced complete resolution of their symptoms, 10% had greater than 30% reduction in their symptoms and 10% had no change in symptoms. Two patients had only temporary relief of symptoms after reversal. Two patients went on to have microsurgical spermatic cord denervation after failed reversal and one patient ultimately elected to have a unilateral orchidectomy. One cord denervation was ultimately successful.
CONCLUSIONS: Post-vasectomy pain syndrome continues to be a problem plaguing a small number of vasectomized men. Pain appears to vary in its time to onset, is inconsistent in nature and quality, and probably has multiple pathologic etiologies. Adequate anesthesia for the vasectomy is crucial since most patients began experiencing pain during the procedure. Vasectomy reversal has a very high likelihood of producing a symptom-free outcome. Sperm granulomata, inflammatory/scar tissue, and foreign bodies should be excised at the time of reversal surgery. Open-ended vasectomy should be avoided as it made subsequent reversal surgery more difficult to perform.
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