Abstract
This is the first systematic review and meta-analysis to ascertain incidences of post-vasectomy pain following traditional scalpel, or non-scalpel vasectomy. Electronic databases PubMed, Embase and PsycINFO were searched up to 1 July 2019 for peer-reviewed articles recording post-vasectomy pain. We identified 733 publications, screened 559 after removal of duplicates and excluded 533. Of the remaining 26 full-text articles, 8 were excluded with reasons, leaving 18 for detailed analyses. Meta-analysis was performed on 25 separate datasets (11 scalpel, 11 non-scalpel, 3 other/combined). Study follow-up ranged from 2 weeks to 37 years and sample sizes from 12 to 723 patients. The overall incidence of post-vasectomy pain was 15% (95% CI 9% to 25%). The incidences of post-vasectomy pain following scalpel and non-scalpel techniques were 24% (95% CI 15% to 36%) and 7% (95% CI 4% to 13%), respectively. Post-vasectomy pain syndrome occurred in 5% (95% CI 3% to 8%) of subjects, with similar estimates for both techniques. We conclude that the overall incidence of post-vasectomy pain is greater than previously reported, with three-fold higher rates of pain following traditional scalpel, compared to non-scalpel vasectomy, whereas the incidence of post-vasectomy pain syndrome is similar.
Highlights
Vasectomy is a form of permanent contraception which is increasingly considered as men age beyond mid-life
The primary outcome measure was the incidence of post-vasectomy pain, presenting two weeks or later after the procedure, ensuring that pain was not related to any post-surgical complication such as infection, haematoma, bleeding or incisional pain
For scalpel and non-scalpel vasectomy, 26 peer reviewed articles remained after exclusion with 18 publications providing estimates for 25 sets of data for meta-analysis (11 scalpel, 11 non-scalpel, 3 other/combined)
Summary
Vasectomy is a form of permanent contraception which is increasingly considered as men age beyond mid-life. Vasectomy is achieved in two parts: exposing the vas deferens out of the scrotum (isolation) and blocking the vas (occlusion). Isolation can be done conventionally using a scalpel to make an incision through the scrotum or by a non-scalpel vasectomy (NSV). This involves clamping the vas and overlying skin by an extracutaneous ring and piercing the skin using pointed dissection forceps to gain access. As for occlusion, different methods were developed in order to reduce complications. These include excision and ligation, surgical clips, thermal or electrocautery, intraluminal mucosal cautery or chemical occlusion
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