Vasectomy reversal for post-vasectomy pain syndrome

Abstract

Post-vasectomy pain syndrome (PVPS) is a rare, but devastating outcome following vasectomy. Given the widespread utilization of vasectomy for permanent contraception, with more than 500,000 procedures performed annually in the United States, it can be a significant challenge for both patients and providers. Vasectomy reversal is a surgical option for men who fail conservative or medical management. Despite improvements in technique, vasectomy carries some inherent risks making pre-procedure counseling regarding the risks of PVPS paramount. Chronic post-operative pain, or PVPS, occurs in 1–2% of men undergoing the procedure. This review will examine the utility of vasectomy reversal as a means of addressing PVPS.

UPDATE – 2022 Canadian Urological Association best practice report: Vasectomy

“…1,5,6 Complications, such as bleeding and testicular pain, can often be managed medically but infrequently (<0.1%) these conditions may require a surgical intervention. 7,8 Exceptionally, surgical management of these complications may lead to testicular atrophy or an orchiectomy. Such information should be discussed verbally, and an information pamphlet should also be provided.…”

<p>Management of Chronic Orchialgia: Challenges and Solutions – The Current Standard of Care</p>

“…Success of significant reduction in pain from a vasectomy reversal in these CSP patients ranges in the 69–100% range. 6 , 70 , 71 If CSP patients who undergo a vasectomy reversal still have persistent pain, then targeted blocks, MDSC/TMDSC are also viable treatment options. 21 In CSP patients with PVPS who have more constant, unilateral or nerve-type pain, MDSC/TMDSC may be a better option.…”

Surgery of the Male Genital Tract

“…Initial treatment options include nonsteroidal antiinflammatory drugs, tricyclic antidepressants, nerve blocks, gabapentin (Neurontin), as well as acupuncture and other complementary approaches. Surgical vasectomy reversal is used in some cases to manage post-vasectomy pain syndrome due to epididymal congestion, but it is not always successful in resolving the pain, and may restore fertility [29]. Another treatment for post-vasectomy pain is surgical removal of the epididymis (epididymectomy); this is technically easier than vasectomy reversal and leaves the patient sterile.…”