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VASECTOMY REVERSAL FOR THE POST-VASECTOMY PAIN SYNDROME: : A CLINICAL AND HISTOLOGICAL EVALUATION

2000; Lippincott Williams & Wilkins; Volume: 164; Issue: 6 Linguagem: Inglês

10.1016/s0022-5347(05)66923-6

1527-3792

Ajay K. Nangia, Jonathan Myles, Anthony J. Thomas,

Reproductive Health and Technologies

No AccessJournal of UrologyCLINICAL UROLOGY: Original Articles1 Dec 2000VASECTOMY REVERSAL FOR THE POST-VASECTOMY PAIN SYNDROME: : A CLINICAL AND HISTOLOGICAL EVALUATION AJAY K. NANGIA, JONATHAN L. MYLES, and ANTHONY J. THOMAS AJAY K. NANGIAAJAY K. NANGIA , JONATHAN L. MYLESJONATHAN L. MYLES , and ANTHONY J. THOMASANTHONY J. THOMAS View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)66923-6AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: The cause of the post-vasectomy pain syndrome is unclear. Some postulated etiologies include epididymal congestion, tender sperm granuloma and/or nerve entrapment at the vasectomy site. To our knowledge nerve proliferation has not been evaluated previously as a cause of pain. Vasectomy reversal is reportedly successful for relieving pain in some patients. We report our experience and correlate histological findings in resected vasal segments with outcome to explain the mechanism of pain in these patients. Materials and Methods: We retrospectively reviewed the records of 13 men who underwent vasectomy reversal for the post-vasectomy pain syndrome. We compared blinded histological evaluations of the vasal ends excised at vasectomy reversal in these patients with those of pain-free controls who underwent vasectomy reversal to reestablish fertility. Controls were matched to patients for the interval since vasectomy. Histological features were graded according to the degree of severity of vasitis nodosum, chronic inflammation and nerve proliferation. Results: Mean time to pain onset after vasectomy was 2 years. Presenting symptoms included testicular pain in 9 cases, epididymal pain in 2, pain at ejaculation in 4 and pain during intercourse in 8. Physical examination demonstrated tender epididymides in 6 men, full epididymides in 6, a tender vasectomy site in 4 and a palpable nodule in 4. No patient had testicular tenderness on palpation. Unilateral and bilateral vasovasostomy was performed in 3 and 10 of the 13 patients, respectively. Postoperatively 9 of the 13 men (69%) became completely pain-free. Mean followup was 1.5 years. We 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. Conclusions: No histological features aid in identifying a cause of pain or provide prognostic value for subsequent pain relief. Vasectomy reversal appeared to be beneficial for relieving pain in the majority of select patients with the post-vasectomy pain syndrome. References 1 : Epididymectomy for post-vasectomy pain: histological review. Br J Urol1991; 68: 407. Google Scholar 2 : A late post-vasectomy syndrome. J Urol1985; 134: 494. Link, Google Scholar 3 : Spermatic granuloma: an often painful lesion. Fertil Steril1979; 31: 178. Google Scholar 4 : Vasectomy reversal for the treatment of the post-vasectomy pain syndrome. J Urol1997; 157: 518. Link, Google Scholar 5 : Open-ended vasectomy, sperm granuloma, and postvasectomy orchalgia. Fertil Steril1979; 32: 546. Google Scholar 6 : Microsurgical vasovasostomy: two-layer technique. In: Surgery of Male Infertility. Edited by . Philadelphia: W. B. Saunders1994: 104. Google Scholar 7 : End-to-side microsurgical vasoepididymostomy. In: Surgery of Male Infertility. Edited by . Philadelphia: W. B. Saunders1994: 128. Google Scholar 8 : Vasectomy: subclinical pathologic changes. Am J Surg Pathol1981; 5: 767. Google Scholar 9 : Chronic testicular pain following vasectomy. Br J Urol1992; 69: 188. Google Scholar 10 : Questionnaire-based outcomes study of nononcological post-vasectomy complications. J Urol1996; 155: 1284. Link, Google Scholar 11 : Morbidity associated with vasectomy. J Urol1973; 110: 413. Link, Google Scholar From the Urological Institute and Department of Anatomic Pathology, Cleveland Clinic Foundation, Cleveland, Ohio© 2000 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited byCalixte N, Tojuola B, Kartal I, Gudeloglu A, Hirsch M, Etafy M, Mendelson R, Djokic B, Sherba S, Shah K, Brahmbhatt J and Parekattil S (2018) Targeted Robotic Assisted Microsurgical Denervation of the Spermatic Cord for the Treatment of Chronic Orchialgia or Groin Pain: A Single Center, Large Series ReviewJournal of Urology, VOL. 199, NO. 4, (1015-1022), Online publication date: 1-Apr-2018.Parekattil S, Gudeloglu A, Brahmbhatt J, Priola K, Vieweg J and Allan R (2018) Trifecta Nerve Complex: Potential Anatomical Basis for Microsurgical Denervation of the Spermatic Cord for Chronic OrchialgiaJournal of Urology, VOL. 190, NO. 1, (265-270), Online publication date: 1-Jul-2013.Horovitz D, Tjong V, Domes T, Lo K, Grober E and Jarvi K (2018) Vasectomy Reversal Provides Long-Term Pain Relief for Men With the Post-Vasectomy Pain SyndromeJournal of Urology, VOL. 187, NO. 2, (613-617), Online publication date: 1-Feb-2012.Brannigan R (2018) Vasectomy Reversal: Indications and OutcomesJournal of Urology, VOL. 187, NO. 2, (385-386), Online publication date: 1-Feb-2012.Hori S, Sengupta A, Shukla C, Ingall E and McLoughlin J (2018) Long-Term Outcome of Epididymectomy for the Management of Chronic Epididymal PainJournal of Urology, VOL. 182, NO. 4, (1407-1412), Online publication date: 1-Oct-2009. Volume 164Issue 6December 2000Page: 1939-1942 Advertisement Copyright & Permissions© 2000 by American Urological Association, Inc.Keywordsvasectomytestisvasovasostomypaininfertility, maleMetricsAuthor Information AJAY K. NANGIA More articles by this author JONATHAN L. MYLES More articles by this author ANTHONY J. THOMAS More articles by this author Expand All Advertisement PDF downloadLoading ...