Post Vasectomy Pain (PVP)
What is PVP?
• A chronic relapsing testicular ache whose onset may be as little as 8 weeks to as long as 5 years or more post vasectomy.
• PVP may occur immediately after ejaculation or the pain may be of insidious onset over subsequent days.
• The pain is chronic, lasting for years with relapses usually lasting 1-4 days though very variable in frequency
• Often the pain is unilateral or at least more severe on one side than the other.
• PVP should, where possible, be a diagnosis of exclusion after investigation has failed to identify any other lumbar of urological abnormality’.
We advise exclusion of lumbar spinal problems, prostatic disease, infection in the epididymis and varicocoele.
Spectrum of severity
As with other diseases there is a spectrum of severity with symptoms varying from trivial and short lived, to severe and persistent. At its most severe PVP can affect the patient’s everyday life leading to irritability, depression and relationship problems. GPs, urologists and ultrasound departments will all be familiar with vasectomy patients reporting post vasectomy discomfort. Most PVP suffers will be reassured by the exclusion of testicular malignancy by a normal US Scan but some will require intervention.
Examination generally shows a completely normal testis but a swollen, often tender epididymis in which there can be firm swellings, possible concretions due to sperm stasis. On the vas, sperm granuloma may be present but in our experience does not cause PVP.
Various suggestions have been made, neurological damage at the site of vasectomy, epididymal distension and formation of sperm granuloma. Investigation has shown that there are no histological correlations post vasectomy changes in the vas, epididymis or testis so the presence of PVP is an individual response to the vasectomy. At Dawson Microsurgery we believe that PVP is caused by pressure build up in the epididymis leading to distension of this delicate structure and its overlying fascia. Over the last 10 years we have performed reversal of vasectomy for approximately 24 PVP sufferers. We also have experience PVP as an incidental finding (over 100 cases) in men requiring return of fertility. Overall, reversal in this clinic leads to complete resolution of pain in over 90% of cases.
Various teatments have been devised for PVP. These include excision of the epididymis(Epidydimectomy) converting the vasectomy to open ended and reversal of vasectomy and in extreme cases removal of testis. In our view reversal is a good option as this is a simple day case procedure without risk of significant complication and has a proven high success rate. Reversal of the vasectomy allows the accumulted sperms and fluid to drain freely thus allowing the epididymis to deflate and return to normal One word of caution, if the connection scars and closes the pain is likely to return, so excellence of technique, quality and accuracy of microsurgery, is all important.
As with any treatment for any pain, there is no guarantee of relieving the pain and of course there are risks associated with any treatments medical or surgical including Reversal.