An overview of the management of post-vasectomy pain syndrome

Abstract

Post-vasectomy pain syndrome remains one of the more challenging urological problems to manage. This can be a frustrating process for both the patient and clinician as there is no well-recognized diagnostic regimen or reliable effective treatment. Many of these patients will end up seeing physicians across many disciplines, further frustrating them. The etiology of post-vasectomy pain syndrome is not clearly delineated. Postulations include damage to the scrotal and spermatic cord nerve structures via inflammatory effects of the immune system, back pressure effects in the obstructed vas and epididymis, vascular stasis, nerve impingement, or perineural fibrosis. Post-vasectomy pain syndrome is defined as at least 3 months of chronic or intermittent scrotal content pain. This article reviews the current understanding of post-vasectomy pain syndrome, theories behind its pathophysiology, evaluation pathways, and treatment options.

Figure 1

Treatment algorithm for patient with postvasectomy pain syndrome.

Figure 2

Microdenervation of the spermatic cord. (a) Marking of inguinal site. (b) Dissection to expose spermatic cord. (c) Spermatic cord supported by 5/8 inch Penrose drain with cord fascia opened. (d) Arteries secured by blue Vessel loop. (e) After completion of dissection, only the cremasteric artery, testicular artery, deferential artery, lymphatics remain (top to bottom).