Vasectomy reversal for the post-vasectomy pain syndrome: A clinical and histological evaluation

Purpose: The cause of the post-vasectomy pain syndrome is unclear. Some pos tulated etiologies include epididymal congestion, tender sperm granuloma an d/or nerve entrapment at the vasectomy site. To our knowledge nerve prolife ration has not been evaluated previously as a cause of pain. Vasectomy reve rsal is reportedly successful for relieving pain in some patients. We repor t our experience and correlate histological findings in resected vasal segm ents with outcome to explain the mechanism of pain in these patients. Materials and Methods: We retrospectively reviewed the records of 13 men wh o underwent vasectomy reversal for the post-vasectomy pain syndrome. We com pared blinded histological evaluations of the vasal ends excised at vasecto my reversal in these patients with those of pain-free controls who underwen t vasectomy reversal to reestablish fertility. Controls were matched to pat ients for the interval since vasectomy. Histological features were graded a ccording 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 sy mptoms included testicular pain in 9 cases, epididymal pain in 2, pain at e jaculation in 4 and pain during intercourse in 8. Physical examination demo nstrated tender epididymides in 6 men, full epididymides in 6, a tender vas ectomy site in 4 and a palpable nodule in 4. No patient had testicular tend erness on palpation. Unilateral and bilateral vasovasostomy was performed i n 3 and 10 of the 13 patients, respectively. Postoperatively 9 of the 13 me n (69%) became completely pain-free. Mean followup was 1.5 years. We observ ed 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 wh o 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 ap peared to be beneficial for relieving pain in the majority of select patien ts with the post-vasectomy pain syndrome.