Vasectomy Reversal Provides Long-Term Pain Relief for Men With the Post-Vasectomy Pain Syndrome

Division of Urology, Mount Sinai Hospital, Toronto, Ontario, Canada.
The Journal of urology (Impact Factor: 4.47). 12/2011; 187(2):613-7. DOI: 10.1016/j.juro.2011.10.023
Source: PubMed


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.

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    • "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). "
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