The post-vasectomy pain syndrome is a rare but serious and debilitating complication of vasectomy. For men with the post-vasectomy pain syndrome vasectomy reversal is a surgical option after medical management has failed. However, there is a paucity of data in the literature defining its therapeutic efficacy. In this study we better define the role and effect of vasectomy reversal in the treatment of men with the post-vasectomy pain syndrome.
Three urologists in Toronto, Ontario performed 149 publically funded vasectomy reversals between January 2000 and September 2010. The electronic health records were reviewed and 23 of the 149 (15%) procedures were performed for the post-vasectomy pain syndrome. Of these men who underwent 14 vasovasostomies 13 completed a telephone conducted questionnaire (response rate 56%). Patient demographics, preoperative and postoperative pain scores, and quality of life were retrospectively assessed.
Orchialgia occurred a mean ± SD of 19 ± 42.5 months after vasectomy and the men (mean age 43.8 ± 5.2 years) experienced pain for 50.3 ± 34.9 months before vasovasostomy. After vasovasostomy improvement of pain occurred in 93% (13 of 14) and 50% were rendered pain-free with an average improvement in pain intensity scores of 65% (p <0.005). Of the men 15% (2 of 13) had a recurrence of pain to baseline but overall 79% (11 of 14) had a durable positive response. Quality of life was significantly improved after vasovasostomy (p <0.005) and 93% (13 of 14) of the patients said they would undergo the same operation again.
Vasovasostomy is an effective treatment modality for the post-vasectomy pain syndrome, and it can achieve robust and durable long-term improvement in pain intensity and quality of life.
"Epididymal granuloma formation and focal orchitis are reported in vasectomized men, but the etiology and precise frequencies are not defined (Adams and Wald, 2009). Also undetermined are the precise mechanism for post-vasectomy pain syndrome (Horovitz et al., 2012) and the mechanism of infertility in vasovasostomy subjects, despite restoration of sperm count (van Dingen et al., 2012). Post-vasectomy autoantibody to sperm and autoimmune orchitis are well documented in all animal species, including humans (Tung and Menge, 1985; Alexander and Anderson, 1979), associated with deposition of meiotic germ cell antigen (MGCA) antibody complexes outside the Sertoli cell barrier (Bigazzi et al., 1976; Alexander and Tung, 1977). "
[Show abstract][Hide abstract] ABSTRACT: CD4+ CD25+ regulatory T cells (Tregs) strongly influence the early and late autoimmune responses to meiotic germ cell antigens (MGCA) and the gonadal immunopathology in vasectomized mice. This is supported by the published and recently acquired information presented here. Within 24h of unilateral vasectomy (uni-vx) the ipsilateral epididymis undergoes epithelial cell apoptosis followed by necrosis, severe inflammation, and granuloma formation. Unexpectedly, vasectomy alone induced MGCA-specific tolerance. In contrast, uni-vx plus simultaneous Treg depletion resulted in MGCA-specific autoimmune response and bilateral autoimmune orchitis. Both tolerance and autoimmunity were strictly linked to the early epididymal injury. We now discovered that testicular autoimmunity in uni-vx mice did not occur when Treg depletion was delayed by one week. Remarkably, this delayed Treg depletion also prevented tolerance induction. Therefore, tolerance depends on a rapid de novo Treg response to MGCA exposed after vasectomy. Moreover, tolerance was blunted in mice genetically deficient in PD-1 ligand, suggesting the involvement of induced Treg. We conclude that pre-existing natural Treg prevents post-vasectomy autoimmunity, whereas vasectomy-induced Treg maintains post-vasectomy tolerance. We further discovered that vasectomized mice were still resistant to autoimmune orchitis induction for at least 12-16 months; thus, tolerance is long-lasting. Although significant sperm autoantibodies of low titers became detectable in uni-vx mice at 7 months, the antibody titers fluctuated over time, suggesting a dynamic "balance" between the autoimmune and tolerance states. Finally, we observed severe epididymal fibrosis and hypo-spermatogenesis at 12 months after uni-vx: findings of highly critical clinical significance.
[Show abstract][Hide abstract] ABSTRACT: Vasectomy reversal is the most common microsurgical intervention for the treatment of male infertility. Originally introduced in 1977, microsurgical vasectomy reversal has become highly sophisticated and is a minimally invasive, highly efficient and cost-effective treatment option for men with a desire to have children after vasectomy. It can be an effective physiological method of restoring fertility in more than 90% of vasectomized men. Although assisted reproductive technology (ART) is an alternative to vasectomy reversal, it is normally associated with higher costs without offering higher cumulative chances of a pregnancy. Recovery of physiological male fertility can take up to 2 years after vasectomy reversal, especially if reversal is performed >10 years after vasectomy, owing to impaired epididymal function. Under these circumstances, ART can be used to bridge the time until recovery of natural fertility. Although the basic principles of microsurgical vasovasostomy have been established since the late 1970s, there have since been numerous technical innovations to improve the delicate operation and promising new technical modifications, particularly for vasoepididymostomy, have been described. Robotic vasectomy reversal is an emerging field in specialized urologic centers, but whether the high quality of conventional microsurgical vasectomy reversal can be matched by robotic platforms is yet to be seen.
[Show abstract][Hide abstract] ABSTRACT: Los dolores pelviperineales crónicos presentan una evolución superior a 6 meses y se asimilan completamente a síndromes; asocian varios síntomas, sobre todo urinarios o sexuales, y fenómenos psicológicos, orgánicos y psicosomáticos. Fuente de discapacidad, estos síndromes alteran la calidad de vida del paciente y su personalidad e influyen en su comportamiento y su vida sexual, familiar, social y laboral. El conjunto de los síndromes dolorosos pelviperineales crónicos incluye la prostatitis bacteriana, el síndrome doloroso pélvico (antigua prostatitis crónica no bacteriana), el síndrome doloroso vesical, los dolores uretrales, escrotales, epidídimo-testiculares, peneanos, los dolores con la eyaculación, los dolores neuropáticos somáticos (incluida la neuralgia pudenda), los dolores musculoesqueléticos, los dolores irradiados y los dolores postoperatorios. En ausencia de etiología orgánica, tisular o iatrogénica, un síndrome doloroso pelviperineal crónico podría corresponder a una forma de hipersensibilización urogenital, posiblemente secundaria a antecedentes nociceptivos locales repetidos, como por ejemplo infecciosos o traumáticos, y reflejar una disfunción de la transmisión nociceptiva y la regulación de los mensajes dolorosos pelviperineales. Debido a su complejidad y a sus múltiples implicaciones, los síndromes dolorosos pelviperineales crónicos requieren un enfoque global y transdisciplinario. Existe un amplio arsenal terapéutico (tratamientos farmacológicos orales o locales, principalmente mediante infiltraciones, fitoterapia, fisioterapia, psicoterapia, neuromodulación, acupuntura, cirugía), pero su eficacia es con frecuencia limitada y carece de validación. Son indispensables estudios de investigación fundamental o clínica de alto nivel de evidencia científica para progresar en la comprensión, la valoración y el manejo de los dolores pelviperineales crónicos.
Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.