PVPS Research Articles

Complications of vasectomy: results from a prospective audit of 105 393 procedures.

To provide up-to-date complication rates for vasectomy in the UK using 15 years of data collected by the Association of Surgeons in Primary Care (ASPC). Data were collected between 2007 and March 2022. A patient questionnaire was completed on the day of surgery and at 4 months postoperatively. Rates of early and late failure, infection, hospital admission or re-admission, haematoma and post-vasectomy pain syndrome (PVPS) were recorded. There were no specific exclusion criteria. Complication rates were compared to those published by major urological organisations. Descriptive statistics were utilised, without formal statistical analysis. Over the 15-year study period, data from 105 393 vasectomies were collected, performed by >150 surgeons. In 2022, 94.4% of surgeons used one test to prove sterility. In all, 65% of patients used a postal sperm test after vasectomy to confirm sterility. Early failure rates were available for 69 500 patients. Early failure occurred in 648 patients (0.93%). Of 99 124 patients, late failure occurred in 41 (0.04%). Of 102 549 vasectomies, postoperative infection was reported in 1250 patients (1.22%), haematoma in 1599 patients (1.56%), and PVPS was reported in 139 patients (0.14%). Vasectomy remains a safe and reliable contraceptive method. The rates of complication were generally lower than those published by major urological organisations. This large, prospective audit provides accurate, contemporaneous complication rates that can form the basis for pre-vasectomy counselling.

Cost Removed! Do Different Factors Influence Motivation for Vasectomy Reversal When Cost Is Not an Issue?

Vasectomy is a relatively common procedure performed for the purposes of sterilization; however, up to 6% of men that undergo vasectomy wish for its reversal at some point. Few studies have examined the motivation behind vasectomy reversal (VR), especially within special populations, such as the U.S. Military. The aim of this study was to examine the motivations of U.S. Military service members (SMs) who opted for VR surgery, considering their unique access to free health care. We conducted a retrospective record review of microsurgical VRs performed by a single surgeon (DJH) between January 2020 and May 2023. We evaluated patient's age at which vasectomy was performed, age at VR, reasons for seeking VR surgical care, number of children fathered before the vasectomy, and the age of the current partner. A total of 106 patients underwent VR during the study period, and 102 of them had their medical records available for review. The average age at the time of vasectomy was 31.3 years, while the average age at VR was 40.2 years. The average spousal age at the time of seeking VR was 34.8 years. Before undergoing vasectomy, the men had fathered an average of 2.7 children. Most men were enlisted members of the military (68) and of all service branches, Army represented the greatest number (50). The vast majority of men (76) cited having a new partner after divorce as the primary motivation for seeking VR. Within this group, 57 were remarried, 15 were in a new relationship, 3 were newly engaged, and 1 desired fertility for future relationships. Additionally, 21 sought VR to have more children with the same spouse. Among them, motivating factors included changes to financial status and improvement in partner's health condition. A minority of patients (2) desired VR due to post vasectomy pain syndrome or religious beliefs. Our study demonstrates that the primary driver for seeking VR surgical care among SMs was the desire for fertility with a new partner, which correlates with trends in the civilian sector. Approximately 20% of the men cited the wish to have more children with the same partner as their motivation. Non-fertility reasons, such as religious beliefs and post vasectomy pain syndrome, were also observed, albeit less frequently.

A simplified treatment algorithm for chronic scrotal content pain syndrome

Abstract Background Chronic scrotal content pain (CSCP) is a devastating condition characterized by localized scrotal pain that persists for ≥ 3 months and interferes with daily activities. Approximately 2.5% of all urology outpatient visits are associated with CSCP. General urologists may have difficulty treating these patients because of uncertainties regarding the etiology and pathophysiology of CSCP. Therefore, we aimed to provide a simplified diagnostic and treatment approach for CSCP by subdividing it into distinct categories. Materials and methods We systematically reviewed the published literature in the PubMed, MEDLINE, and Cochrane databases for all reports on CSCP diagnosis and treatment using the keywords “chronic scrotal content pain,” “testicular pain,” “orchialgia,” “testicular pain syndrome,” “microdenervation of the spermatic cord,” “post-vasectomy pain syndrome,” “post-inguinal hernia repair pain,” “testialgia,” and “pudendal neuralgia.” This review included only CSCP-related articles published in English language. Results We subdivided CSCP syndrome into 5 clinical presentation types, including hyperactive cremasteric reflex, pain localized in the testicles, pain in the testis, spermatic cord, and groin, pain localized in the testicles, spermatic cord, groin, and pubis, and pain in the testicles, spermatic cord/groin, and penis/pelvis. Treatments were adjusted stepwise for each type and section. We included more information regarding the role of pudendal neuroglia in CSCP syndrome and discussed more options for nerve blocks for CSCP. For microsurgical spermatic cord denervation failure, we included treatment options for salvage ultrasound-guided targeted cryoablation, Botox injections, and posterior-inferior scrotal denervation. Conclusions Different CSCP subtypes could help general urologists assess the appropriate diagnostic and treatment approaches for scrotal pain management in daily practice.

(O-25) SURGICAL TREATMENT FOR CHRONIC TESTICULAR PAIN: A SYSTEMATIC REVIEW

Abstract Introduction and Objetives Chronic testicular pain (CTP) is defined as 3 months of intermittent or constant testicular pain that is significantly bothersome to the patient. There exist a variety of different surgical treatment options for CTP. They are generally kept as second or even third-line option for persistent cases. This study aims to review and elucidate the literature about surgical treatment for chronic testicular pain. Methods We searched Pubmed, Embase and Cochrane for articles evaluating surgical treatments for CTP. Search terms included “orchialgia”, “spermatic cord”, “chronic scrotal pain”, “chronic testicular pain” and “surgery”. Results Microsurgical Denervation of the Spermatic Cord (MDSC) is the surgical standard when a procedure is indicated for idiopathic chronic orchialgia unresponsive to conservative therapies. The positive response to spermatic cord block is a predictor of MDSC response. Pain relief after MDSC ranges from 76% to 100%. Ultrasound-guided targeted cryoablation could be used in persistent CTP after MDSC with 75% success rate. Epididymectomy is better indicated for CTP in structural abnormality such as cyst, granuloma or mass, with pain relief reaching 50% to 92%. In case of post-vasectomy pain syndrome, vasectomy reversal and MDSC has an overall success from 50% to 100% and 71% to 81% respectively. Ilioinguinal and genitofemoral peripheral nerve stimulation could be used in persistant CTP, and spinal cord stimulation as well. Orchiectomy can be considered as a last resort in case patients do not respond to other forms of treatment, but do not delivers a 100% relief a pain. Conclusion Although it’s variables choices, there is not a gold standard surgical treatment for CTP, representing a challenge for clinicians. Large, controlled trials must be performed to establish strong and reliable evidence for the surgical treatment of CTP. Financing No conflict.

(385) Compliance with Post-Vasectomy Semen Analysis (PVSA): A Retrospective Survey Study

Abstract Introduction After undergoing vasectomy, sterility must be confirmed with PVSA obtained ~12 weeks and at least 20 ejaculations after the procedure. Sterility is defined as azoospermia or rare non-motile sperm (<100,000 non-motile sperm/mL). In the literature, compliance for obtaining PVSA has been reported at ~53%. Prior retrospective research has demonstrated that the compliance rate for PVSA at our institution is considerably higher than this, at 89%, which may relate to practice patterns that improve follow-up. Noncompliance has been linked to a number of patient circumstances, though limited studies have explored this from the patient’s perspective. Objective To identify patient-related factors associated with PVSA compliance and describe perceived barriers for not obtaining PVSA. Methods An anonymous survey was sent via REDCap to patients who underwent vasectomy at our institution from February 2020 to February 2023 (n = 134, 14.4 RR; 7.3% in 2020, 31.8% in 2021, 60.9% in 2022). Participants provided demographics, answered questions about their vasectomy, and reported reasons for completing or failing to complete PVSA (IRB 2022H0457). Results Study Sample: Patients were 98.4% cis male, 88.7% heterosexual, and 93.2% white, with a mean age of 37.9 years (SD = 6.05 yrs). The majority of patients held a Bachelor’s degree or higher (79.6%) and the mean reported annual income was $100,000–150,000. Eighty-two percent of patients were married; the majority had been married for more than 5 years (85.3%). Seventy-four percent had at least one child. Fifty-one percent said insurance covered the procedure completely while 48% said insurance covered the procedure partially. Survey Results: Patients rated their vasectomy procedure pain at 4.3/10 (SD = 2.6) and their post-vasectomy pain at 3.6/10 (SD = 2.03). Patients reported an average out-of-pocket cost for their vasectomy of $439.57 (SD = $358.66). Ninety-nine percent of patients said they had completed their PVSA and 16.2% reported that there was an out-of-pocket cost for their SA. PVSA Compliance Factors: 97.5% of patients were told about the need to verify their sterility at their initial consultation, 97.5% were told this again on their procedure day, 99.2% were given clear PVSA instructions, 92.4% had their lab appointment pre-scheduled, 89.9% were given a semen cup, and 80.7% received an appointment reminder for their SA. Ninety-five percent of patients were sterile on their first SA; of the 5.1% who were not, all but one had already completed a second SA. We asked men what made them most likely to comply with getting a PVSA. The most popular answer was being provided with an appointment reminder, followed by lab proximity to home. Conclusions Our institution has an impressively high PVSA compliance, possibly because of several workflow interventions, including appointment reminders, pre-scheduling of PVSA, and repetitive provider-facilitated engagement about PVSA necessity. Lab-home proximity is specifically important to patients, likely because it allows for them to obtain specimen at home. These results may provide a model for other institutions and centers hoping to increase their PVSA compliance. Disclosure No.

(334) Robotic Transabdominal Vasovasostomy Following Laparoscopic Vasectomy: A Case Series

Abstract Introduction A small subset of men undergoing laparoscopic hernia repair will request concomitant vasectomy, which is typically performed via resection of a segment of the intra-abdominal vas deferens near the inguinal ring. Some of these men will ultimately desire vasectomy reversal to restore fertility or alleviate post-vasectomy pain syndrome. Traditional scrotal or inguinal microsurgical techniques are clearly not feasible in this situation, and open surgical repair carries significant morbidity. The use of a robotic approach may offer an attractive alternative to improve visualization and facilitate a patent intra-abdominal anastomosis. Objective To demonstrate technical feasibility and report institutional outcomes of robotic-assisted laparoscopic transabdominal vasectomy repair Methods IRB approval was obtained. A retrospective chart review of our institutional experience with this operation was performed. Preoperative, operative, and postoperative data was collected. Results Three cases were identified with a mean patient age of 43 and mean interval of 6 years (range 3-10 years) between vasectomy and reversal attempt. Two men desired restoration of fertility, and one man desired reversal for testicular pain. All patients had previously fathered children, and mean partner age was 30 years. Port placement was similar to standard W-configuration used for robotic prostatectomy. Mean operative time was 319 minutes and estimated blood loss was 27mL. Two men required a modified Prentiss maneuver to re-route the vas deferens to obtain additional length. Indocyanine green was used in one case to confirm vasal perfusion. Bilateral vasovasostomy was completed in all cases with either a modified one-layer anastomosis using 8-0 nylon or a two-layer anastomosis using 10-0 and 9-0 nylon. Both men undergoing fertility restoration had return of sperm in the ejaculate with a mean concentration of 62 million sperm/mL, and the solitary patient with pain had subjective resolution of his pain. Conclusions Robotic transabdominal vasectomy reversal is technically challenging but feasible with an experienced team including a robotic surgeon and andrologist. Outcomes appear to be satisfactory. This technique may be considered for men who have undergone abdominal vasectomy and desire restoration of fertility or treatment of post-vasectomy pain syndrome. Disclosure No

Anti-adhesion agent to prevent of post-operative adhesion and fibrosis after vasectomy: a study using a rat model.

BackgroundPost-vasectomy pain syndrome (PVPS) is difficult to treat. Direct damage to the vas deferens, inflammation, compression of nerves through fibrotic adhesions, and congestion of the epididymis are known to cause PVPS. The purpose of this study was to evaluate whether the application of anti-adhesion agents after vasectomy can reduce the degree of adhesion and fibrosis in a rat model.MethodsIn the study, 11 Sprague-Dawley rats (22 vas deferens) from each group were evaluated. In the experimental group, surgery was terminated after applying the anti-adhesion agent; this was not applied in the control group. After 14 days of vasectomy, the scrotum was dissected to evaluate the degree of gross adhesion at the vasectomy site. Histological examination of the surrounding tissues, including the vas deferens and the spermatic cord, was also performed.ResultsAdhesions were not observed in 72.73% (16/22) rats from the experimental group, in which the anti-adhesion agent was applied; in contrast, the incidence of adhesions in the control group was 100%. There was a statistically significant relationship between the distribution of grades for adhesion and anti-adhesion agent (chi-square, P<0.001). On classification of fibrosis and inflammation, application of the anti-adhesion agent was significantly associated with lower grade inflammation and fibrosis compared to that of the control group (chi-square, P=0.001). The rate of intact muscle structure was 90.91% (20/22) in the experimental group, and 36.36% (8/22) in the control group, and the application of the anti-adhesion agent demonstrated significant association with preservation of intact muscle structure (chi-square, P<0.001).ConclusionsThe application of an anti-adhesion agent after vasectomy prevented the development of adhesion, fibrosis, and inflammation reaction and further reduced structural destruction.

Current trends and therapies in orchialgia management

The management of pain is a complex condition that will be encountered by most practicing clinicians. In the genitourinary community, testicular pain may be classified as acute or chronic. Initial evaluation of chronic groin and scrotal content pain (CGSCP) begins with a detailed history and physical examination to elucidate the presenting pathology. Multiple therapy algorithms have been proposed with no definitive consensus; however, most begin with conservative intervention and medical management prior to advancing to more invasive procedures. Surgical approaches may range from reconstruction, as in vasovasostomy for post-vasectomy pain syndrome, to excision of the offending agent, as in epididymectomy. This review seeks to focus on chronic pain in the genitourinary community and review techniques of pain management in the current intervention for orchialgia, as well as identify future methods of treatment.

Preoperative Predictors of Failure of Microsurgical Spermatic Cord Denervation for Men With Chronic Orchialgia

ObjectiveTo evaluate predictors of failure of microsurgical spermatic cord denervation (MSCD) for men with chronic orchialgia. MethodsRetrospective chart review of men who underwent MSCD. Outcomes were recorded with potential preoperative predictors of failure. ResultsOne hundred and five men underwent MSCD, and of those, 38 were bilateral for a total of 143 testicular units. Overall, 97 of 143 (67.8%) had complete resolution of pain, 27 of 143 (18.9%) had improvement of pain, and 19 of 143 (13.3%) were considered failures with either no improvement or less than 50% improvement in pain after MSCD with a 1-year follow-up period. Overall, 59 of 143 (41%) presented with intermittent orchialgia while 84 of 143 (59%) presented with constant pain. The mean preoperative visual analog scale was 6.8 ± 2 and the mean duration of pain prior to MSCD was 62.5 ± 100 months. Potential etiologies of pain per testicular unit included previous scrotal/inguinal surgery 17 of 143 (11.9%), postvasectomy pain syndrome (PVPS) 30 of 143 (21%), infectious epididymitis 9 of 143 (6.3%), trauma 15/143 (10.5%), and idiopathic 72/143 (50.3%). The only pre-operative predictor having an association with predicting failure was the etiology of orchialgia. Relative to men who had idiopathic orchialgia or prior scrotal/inguinal surgery inciting orchialgia, men with PVPS had increased odds of failure with MSCD. ConclusionPVPS is an etiology associated with a higher risk of failure to respond to MSCD than idiopathic chronic orchialgia or chronic orchialgia subsequent to scrotal/inguinal surgery.

Etiology of testicular pain 2019: Classification into ten logical subgroups

Background: Testicular pain encompasses a vast medical diagnostic field, with numerous organ and system convergence. Acute testicular pain is a medical emergency that requires accurate evaluation and immediate resolution, whereas chronic testicular pain is enigmatic and requires sound knowledge of the mechanisms of testicular pain and the differential diagnosis.&#x0D; Objective: To review the causes of testicular pain and propose a new etiologic classification consisting of 10 subgroups. &#x0D; Methods: A bibliographic search was carried out utilizing Google and the National Library of Medicine’s PubMed databases to identify original articles and review articles (hard copy or electronic) published on testicular pain, up to March 2020. The search included: MeSH terms: testicular disease (classification, complications, etiology, trauma, microbiology, pathology, pathophysiology, secondary, surgery, treatment) and vasectomy; Non-MeSH terms: acute and chronic orchialgia, scrotalgia, orchidynia, groin pain, epididymalgia, testalgia, chronic testicular pain, chronic scrotal pain syndrome, testicular pain syndrome, epididymal pain syndrome, and post-vasectomy pain syndrome. The initial search produced 625 articles, of which 143 were included in the present review.&#x0D; Results: To better understand testicular pain etiology, 100 possible diagnoses were divided into ten subgroups: infectious, neoplastic, traumatic, torsional, vascular, immunologic, neurologic, pharmacologic, obstructive, and miscellaneous causes. Likewise, treatment can be divided into two main groups, according to therapeutic options: pharmacologic and non-pharmacologic, with the latter subdivided into: noninvasive and the increasingly performed invasive (surgical) alternatives.&#x0D; Conclusions: Testicular pain should be understood as a complex pain syndrome of enigmatic origin. Treatment success depends on the correct identification, from hundreds of possibilities, of the cause of pain. Logical grouping of those possibilities could aid in making the accurate etiologic identification.

Etiology of testicular pain 2019: Classification into ten logical subgroups

Background: Testicular pain encompasses a vast medical diagnostic field, with numerous organ and system convergence. Acute testicular pain is a medical emergency that requires accurate evaluation and immediate resolution, whereas chronic testicular pain is enigmatic and requires sound knowledge of the mechanisms of testicular pain and the differential diagnosis.&#x0D; Objective: To review the causes of testicular pain and propose a new etiologic classification consisting of 10 subgroups. &#x0D; Methods: A bibliographic search was carried out utilizing Google and the National Library of Medicine’s PubMed databases to identify original articles and review articles (hard copy or electronic) published on testicular pain, up to March 2020. The search included: MeSH terms: testicular disease (classification, complications, etiology, trauma, microbiology, pathology, pathophysiology, secondary, surgery, treatment) and vasectomy; Non-MeSH terms: acute and chronic orchialgia, scrotalgia, orchidynia, groin pain, epididymalgia, testalgia, chronic testicular pain, chronic scrotal pain syndrome, testicular pain syndrome, epididymal pain syndrome, and post-vasectomy pain syndrome. The initial search produced 625 articles, of which 143 were included in the present review.&#x0D; Results: To better understand testicular pain etiology, 100 possible diagnoses were divided into ten subgroups: infectious, neoplastic, traumatic, torsional, vascular, immunologic, neurologic, pharmacologic, obstructive, and miscellaneous causes. Likewise, treatment can be divided into two main groups, according to therapeutic options: pharmacologic and non-pharmacologic, with the latter subdivided into: noninvasive and the increasingly performed invasive (surgical) alternatives.&#x0D; Conclusions: Testicular pain should be understood as a complex pain syndrome of enigmatic origin. Treatment success depends on the correct identification, from hundreds of possibilities, of the cause of pain. Logical grouping of those possibilities could aid in making the accurate etiologic identification.

Incidence of Post-Vasectomy Pain: Systematic Review and Meta-Analysis.

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.

Routine Prescription of Opioids for Post-Vasectomy Pain Control Associated with Persistent Use.

The AUA (American Urological Association) Position Statement on opioid use recommends using opioids only when necessary. We sought to determine if routine prescribing of opioids is necessary for pain control after vasectomy, and if an association exists with persistent use. We retrospectively reviewed the charts of patients who underwent vasectomy in clinic between April 2017 and March 2018. Patients were stratified into 2 groups, including those initially prescribed opioids and those not receiving opioid prescriptions at the time of vasectomy. The initial pain medication regimen depended on the standard prescription practice of each provider. Encounters with a medical provider for scrotal pain within 30 days, subsequent opioid prescriptions and new persistent opioid prescriptions between 90 and 180 days were compared between the 2 groups using the Fisher exact test. Between April 2017 and March 2018 a total of 228 patients underwent clinic vasectomy as performed by 8 urologists. At the time of vasectomy 102 patients received opioid prescriptions and 126 received no opioid prescriptions. There was no statistically significant difference between the opioid and nonopioid groups in encounters for scrotal pain (12.7% vs 18.4%, p = 0.279). The incidence of new persistent opioid use was 7.8% in the opioid cohort compared to 1.5% in the nonopioid cohort (p = 0.046). Opioids, which do not appear to be necessary in men who undergo vasectomy, were associated with persistent use in 7.8% of patients at 3 to 6 months. In the face of an opioid epidemic urologists should take action to limit over prescription of opioids after vasectomy.

Osteopathic Manipulative Treatment as a Novel Way to Manage Postvasectomy Pain Syndrome.

Postvasectomy pain syndrome (PVPS) can be debilitating and is notoriously difficult to treat, often requiring a multidisciplinary approach. In this case report, osteopathic manipulative treatment (OMT) was used to treat a patient with PVPS. After vasectomy, an otherwise-healthy man experienced chronic right testicular pain, aggravated by exercise, touch, and sexual intercourse, resulting in marital strain and an inability to perform routine fitness activities. Symptoms persisted for 8 years, despite lifestyle modifications, orally administered pain regimens, pelvic floor physical therapy, nerve blocks, steroid injections, epididymectomy, spermatic cord denervation, and counseling. After the patient's urologist suggested orchiectomy, his family medicine physician referred him for OMT. The OMT interventions, applied over a 4-month period, were directed at the lumbar spine, pelvis, pelvic floor, and lower abdomen. After treatment, the patient reported absence of testicular pain most of the time and described his quality of life as "10 times better." Literature review revealed no reports of OMT used to manage PVPS.

AB040. Post-vasectomy pain syndrome

Persistent pain after vasectomy is bothersome to both patients and urologists. The incidence of long-term pain after vasectomy, the so-called post-vasectomy pain syndrome (PVPS), is variable in the literature, ranging from 0.1% to 15%. The exact cause of PVPS is unknown, but several theories have been proposed, including interstitial fibrosis of the epididymal duct after obstruction of the testicular end of the vas deferens, and sperm granulation formation resulting in perineural fibrosis and inflammation. No risk factors such as immediate postoperative complications, age, socioeconomic status, or vasectomy techniques have been identified for PVPS. Conservative therapy, including scrotal elevation and support, heat or ice packing, and oral pain killers is the first line therapy for PVPS. Those who fail to have response to conservative treatment for at least three months should consider spermatic cord blocks. Surgical interventions could be employed if minimally-invasive procedures fail. Excision of the sperm granulation and intraluminal cautery occlusion of the vas deferens could be applied if the pain is localized to a sperm granulation, while epididymectomy could be performed in patients with palpable tenderness at epididymis. Vasectomy reversal and microscopic denervation of the spermatic cord might be helpful in about 70% of the patients. Inguinal orchiectomy is sometimes useful for severe cases of PVPS. Since PVPS is unpredictable, it is essential to inform the patients of this potential complication during preoperative counseling. More data are warranted to evaluate the role of abdominal robotic microsurgical neurolysis in patients with PVPS unresponsive to orchiectomy.

MP07-13 MICROSURGERY FOR OBSTRUCTIVE AZOOSPERMIA IN A DEVELOPING COUNTRY

You have accessJournal of UrologyInfertility: Therapy II1 Apr 2018MP07-13 MICROSURGERY FOR OBSTRUCTIVE AZOOSPERMIA IN A DEVELOPING COUNTRY Amir Zarrabi Amir ZarrabiAmir Zarrabi More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.3076AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Obstruction is responsible for approximately 40% of cases of azoospermia and may result from epididymal, vasal, or ejaculatory duct pathology. Vasectomy is the most common cause of vasal obstruction. In addition, most vasectomized men will also develop more proximal (epididymal) obstruction within a few years after vasectomy due to epididymal "blow out". Worldwide between 3% and 6% of vasectomized men will desire to have their fertility restored in order to be able to father children again. The objectives of this study were to review the learning curve, complications and outcomes of the first 80 cases of microsurgical vasectomy reversal performed in a developing country (South Africa). METHODS The first dedicated service in male infertility microsurgery in South Africa was established in 2012. Between January 2012 and August 2017, 80 patients underwent microsurgical vasectomy reversal by a single surgeon. Mean patient age was 45 years (range 29 to 66), mean age at vasectomy 33 years (range 19 to 56), mean number of children for the male partner 2,4 and mean age of the female partner 33 years (range 20 to 45). The mean time interval between vasectomy and vasectomy reversal was 11,3 years (range 0,5 to 29,5). Five patients had previous failed vasectomy reversals and in 3 patients the indication for reversal was post-vasectomy pain syndrome. A total of 26% of patients travelled from other countries for their surgery. RESULTS Mean surgical time per testicular unit was 80,2 minutes (range 37 to 115) and total operative time 157 minutes (range 95 to 200). Sperm motility (intra-operative light microscopy) was good in 23,5%, average in 8,4% and poor in 68,1%. Vasovasostomy was required in 45,8% of testicular units and vaso-epididymostomy in 42,2%. In 6 patients sperm was harvested at the time of reversal for cryopreservation. Complications occurred in 21% of patients and were managed conservatively in all but 3, who required an additional surgical procedure. For patients with adequate follow up the overall surgical success rate was 81%. Mean post-operative sperm count was 73,3 million. Eighteen pregnancies have been recorded during the limited follow up. Comparing the first 40 cases with the last 40 cases revealed no significant differences in surgical time, complications or patency rates. The mean post-operative sperm count was 10% higher for the last 40 cases. CONCLUSIONS Although microsurgical vasectomy reversal is technically demanding and requires specialized equipment and instruments, it can be successfully implemented in a developing country © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e92-e93 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Amir Zarrabi More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Microdenervation of the spermatic cord for post-vasectomy pain syndrome.

To evaluate the outcomes of patients who underwent microdenervation of the spermatic cord (MDSC) for post-vasectomy pain syndrome (PVPS) at our institution. A retrospective study of all patients who underwent MDSC for PVPS by a single surgeon between March 2002 and October 2016 was performed. Pain was documented using the numerical rating scale (NRS). Spermatic cord block (SCB) was performed on all patients, and success was defined as NRS score ≤1 for >4 h. All patients had failed medical therapy prior to MDSC. All previous procedures for PVPS had been performed elsewhere. Surgical success was defined as a postoperative NRS score of ≤1. A total of 27 patients with 28 scrotal units underwent MDSC for PVPS. The median (1st quartile; 3rd quartile) follow-up was 10 (2; 16.5) months. The median (range) duration of pain prior to surgery was 57 (8-468) months. Pain was bilateral in 14 (52%), left-sided in eight (30%) and right-sided in five patients (19%). Data on SCB were available for 23 patients, with a success rate of 96%. The median (range) preoperative pain NRS score was 7 (2-10). The median (range) pain score after SCB on the NRS scale was 0 (0-5). The median (range) postoperative pain score on the NRS was 0 (0-9). Overall success was achieved in 20 of 28 testicular units (71%). Patients with involvement of multiple structures in the scrotum (i.e. testis, epididymis, spermatic cord) had a success rate of 81% and were more likely to have a successful surgery (P < 0.001). Five patients had failed a prior epididymectomy and three had failed a vaso-vasostomy for PVPS; this had no correlation with the success of MDSC (P = 0.89). The MDSC procedure is a reasonably successful, durable and valuable approach for PVPS, especially when pain involves multiple structures in the scrotum (testis, epididymis, spermatic cord). MDSC was equally efficacious in patients who had previously failed a procedure for PVPS. No patient had a worsening NRS score after MDSC. This is the largest study to date evaluating MDSC for the treatment of PVPS.

A Thematic Analysis of Online Discussion Boards for Vasectomy

To examine posts on Internet discussion groups related to vasectomies, and identify common ideas through a structured theme analysis. Internet discussion boards were identified using the search term "vasectomy." Three discussion boards were identified as having the most posts and were chosen for analysis. Using an iterative and structured analysis process, each post was analyzed using thematic analysis in 3 steps (open coding, axial coding, and selective coding) to determine common themes. A total of 129 posts were analyzed. The most common posts related to changes in sexual function after vasectomy. The second most common theme was pain after vasectomy. There were also posts about considerations before vasectomy, planning for postvasectomy care, what to expect after vasectomy, potential issues after vasectomy and how to manage these, and feelings about vasectomy. Some of the information present did not have a factual basis. Posts dedicated to postvasectomy pain and sexual dysfunction were of the highest quantity. There was no medical provider input to these discussion boards. Educational efforts should be targeted to these areas and should include a health-care professional.

Micro-Denervation of the Spermatic Cord for Post-Vasectomy Pain Management.

Post-vasectomy pain syndrome (PVPS) is a challenging problem for the practicing urologist because of its unclear pathophysiology and no clearly established protocol for evaluation or treatment. PVPS is defined as at least 3 months of chronic or intermittent scrotal content pain after a vasectomy procedure once other etiologies for the pain have been ruled out. To systematically review the current literature on the effectiveness of micro-denervation of the spermatic cord (MDSC) for PVPS. A systematic literature search using PubMed, Scopus, Medline, Embase, and Cochrane databases for all reports pertaining to PVPS using the Medical Subject Heading terms post vasectomy pain syndrome and micro-denervation of spermatic cord through February2017. Scrotal content pain after MDSC for PVPS. There were nine retrospective studies evaluating MDSC for chronic testicular pain. After omitting repeated series, there were 213 patients who underwent MDSC for chronic orchialgia. Only one study specifically reviewed the outcomes of patients who underwent MDSC for PVPS. In this study, 17 patients underwent MSDC for PVPS, with 13 (76.5%) reporting complete relief of pain at their first follow-up visit. The other four patients had significant improvement in pain and were satisfied with the results. Long-term follow-up data were not available for this study. MDSC remains a valuable approach with high success rates and should be considered for PVPS that is refractory to medical therapy. MDSC appears to have the most success for patients who experience a temporary relief from a cord block and can significantly improve the patient's quality of life and ability to return to daily activities. Tan WP, Levine LA. Micro-Denervation of the Spermatic Cord for Post-Vasectomy Pain Management. Sex Med Rev 2018;6:328-334.

Vasectomy reversal for post-vasectomy pain syndrome.

Post-vasectomy pain syndrome (PVPS) is a rare, but devastating outcome following vasectomy. Given the widespread utilization of vasectomy for permanent contraception, with more than 500,000 procedures performed annually in the United States, it can be a significant challenge for both patients and providers. Vasectomy reversal is a surgical option for men who fail conservative or medical management. Despite improvements in technique, vasectomy carries some inherent risks making pre-procedure counseling regarding the risks of PVPS paramount. Chronic post-operative pain, or PVPS, occurs in 1–2% of men undergoing the procedure. This review will examine the utility of vasectomy reversal as a means of addressing PVPS.