A Late Post-Vasectomy Syndrome

Abstract

A group of 20 surgical specimens in 18 patients with a previously unappreciated syndrome of unremitting epididymal pain and induration 5 to 7 years after vasectomy was collected during a 2-year interval. These symptoms uniformly were unresponsive to conservative measures, including empiric antibiotics. Total unilateral or bilateral epididymectomy and partial vasectomy led to complete relief of symptoms, usually within 24 hours. Pathological examination of the specimens revealed features consistent with sequelae of long-standing obstruction. Recognition of this late post-vasectomy syndrome, which represents a major complication of vasectomy, might be expected to increase as cohorts of vasectomized individuals age.

Vasectomy‐related changes on sonographic examination of the scrotum

“…7 PVPS is believed to result from longstanding obstruction of the efferent ductules of the epididymis, with the increased pressure within the ductules leading to epididymal congestion and pain. 7,8,16 PVPS may also be related to perineural inflammation following extravasation of sperm into the interstitium. 8 Although longstanding obstruction occurs with the occlusion of the vas deferens, sperm granulomas are not commonly seen in PVPS.…”

Clinical Management of Chronic Testicular Pain

“…Alleviation of pain is possible with excision of vasectomy nodules. Similarly, epididymectomy resolves pain in 95% of cases with painful epididymides [17] . The probable mechanism of this relief is due to excision of obstructed, granulomatous and fibrotic epididymis [18] .…”

Risks and Complications of Vasectomy

“…Cultures from excised epididymis support the notion that pain is not caused by infectious etiologies. 1,25,26 A study comparing open-ended versus closedended vasectomy showed a higher rate of congestive epididymitis for closed-ended vasectomy (6% versus 2%; relative risk 3.0 [95% CI, 1.2-7.5]). 27 Additionally, one study reported variations among direct closed-ended techniques.…”