From the Guidelines
The worst potential adverse event after a vasectomy is chronic scrotal pain associated with a negative impact on quality of life, which occurs in about 1-2% of men. This condition can significantly affect a patient's daily life, sexual function, and psychological well-being. According to the American Urological Association guideline on vasectomy 1, chronic scrotal pain is a known complication of the procedure, and patients should be informed about this risk before undergoing vasectomy. The guideline highlights that few men with chronic scrotal pain require additional surgery, implying that treatment options may be available but are not always successful.
Some key points to consider when counseling patients about vasectomy include:
- The risk of chronic scrotal pain and its potential impact on quality of life
- The importance of refraining from ejaculation for approximately one week after vasectomy to minimize the risk of complications
- The availability of options for fertility after vasectomy, such as vasectomy reversal and sperm retrieval with in vitro fertilization, although these options are not always successful and may be expensive
- The rates of surgical complications, such as symptomatic hematoma and infection, which are approximately 1-2% and vary with the surgeon's experience and diagnostic criteria 1.
It is essential to discuss these points with patients before they undergo vasectomy to ensure they are fully informed about the potential risks and benefits of the procedure.
From the Research
Worst Potential Adverse Event after Vasectomy
- The worst potential adverse event after vasectomy is Post-Vasectomy Pain Syndrome (PVPS), a condition characterized by persistent scrotal pain that disrupts daily activities and requires medical intervention 2, 3, 4, 5, 6.
Characteristics of PVPS
- PVPS affects a small but significant percentage of men following vasectomy, with chronic post-operative pain occurring in 1-2% of men undergoing the procedure 3.
- The etiology of PVPS is not clearly delineated, but postulations include damage to the scrotal and spermatic cord nerve structures, back pressure effects in the obstructed vas and epididymis, vascular stasis, nerve impingement, or perineural fibrosis 5.
Treatment Options for PVPS
- Treatment options for PVPS include non-invasive methods such as non-steroidal anti-inflammatory drugs (NSAIDs), tricyclic antidepressants (TCA), and anticonvulsants, as well as surgical interventions like microsurgical denervation of the spermatic cord (MDSC), epididymectomy, vasovasostomy, and orchiectomy 2.
- Vasectomy reversal is a surgical option for men who fail conservative or medical management, and has been shown to be effective in relieving pain in some patients 3, 4, 6.
Effectiveness of Treatment Options
- Studies have demonstrated the effectiveness of various treatment options for PVPS, with vasovasostomy achieving robust and durable long-term improvement in pain intensity and quality of life in 79% of patients 4.
- However, the effectiveness of treatment options can vary depending on the individual case, and an algorithmic evaluation method followed by a patient-specific treatment approach is key to managing PVPS 2.