PVPS Research Articles

Vasectomy Reversal for Treatment of the Post-Vasectomy Pain Syndrome

The post-vasectomy pain syndrome is a rare but troublesome complication of vasectomy. We report our experience with 32 patients who underwent vasectomy reversal for relief of the post-vasectomy pain syndrome. The records of 32 patients undergoing vasovasostomy or epididymovasostomy for the post-vasectomy pain syndrome were evaluated for characteristics of symptoms, previous therapy, interval from vasectomy, success of surgery and duration of relief. Of 32 men who underwent vasectomy reversal for the post-vasectomy pain syndrome between 1980 and 1994, 24 had relief of symptoms after the initial procedure. Of 8 men with recurrent pain 6 underwent a second reversal procedure, and 3 of them subsequently had relief of symptoms. Overall, 27 of 32 men had resolution of pain. In our experience vasectomy reversal has a high rate of success for relief of the post-vasectomy pain syndrome. It does not preclude other forms of surgical therapy and it should be considered in the treatment of the post-vasectomy pain syndrome.

Vasectomy Reversal for Treatment of the Post-Vasectomy Pain Syndrome

Vasectomy Reversal for Treatment of the Post-Vasectomy Pain Syndrome

A comparison of etodolac (Ultradol®) with acetaminophen plus codeine (Tylenol #3) in controlling post-surgical pain in vasectomy patients

SummaryThe efficacy and safety of etodolac (Ultradol®) and acetaminophen plus codeine [A + C (Tylenol #3)] in controlling post-surgical pain were compared in an open-label, randomized, parallel-group outpatient study. Patients who were voluntarily having a vasectomy performed for sterilization were assigned to receive either etodolac 200 mg (20 patients) or A + C (20 patients). All medication was taken as required for up to 7 days. Efficacy assessments were made at 1, 6 and 24 hours after surgery and included pain measurement (Likert Visual Analogue scale), patient and physician global assessments and time to analgesic relief. Safety assessments were made throughout the study and included vital signs and adverse event monitoring. Results of the study indicated that patients taking etodolac were more likely to say they could return to work 24 hours after their vasectomy (p = 0.04). There were no other statistically significant differences between the two groups of patients. The results from this study indicate that etodolac and A + C are equally efficacious and well-tolerated for the control of post-vasectomy pain and that patients may observe an increased benefit with etodolac by being able to return to work sooner.

A comparison of open-end versus closed-end vasectomies: A report on 6220 cases

This study was done to determine if there was a difference in results when both vas ends were closed or when the prostatic end was closed and the testicular end left open. The author performed 6220 vasectomies between June 1, 1972 and June 1, 1992. The first series consisted of 3081 vasectomies in which both ends of the vas deferens were closed. The second series consisted of 3139 vasectomies in which the testicular end of the vas deferens was left open while the prostatic end only was closed. No portion of the vas was excised. Congestive epididymitis was diagnosed in 6% of cases utilizing closed-end vasectomy and 2% of cases where the open-end vasectomy was performed. Open-end vasectomy is recommended because the incidence of congestive epididymitis is reduced.

Epididymectomy for Post‐vasectomy Pain: Histological Review

Fifteen epididymectomies were performed on 10 patients with post-vasectomy pain and 12 specimens were available for histopathological review. The findings were compared with those in 2 groups in which epididymectomy was performed for chronic epididymo-orchitis and epididymal cysts. The results showed that 50% of the post-vasectomy group were cured by simple epididymectomy. Pathological findings revealed features of long-standing obstruction and interstitial and perineural fibrosis which may have accounted for the pain. It is important to recognise this late complication of vasectomy and, if surgery is to be performed, to include all of the distal vas and previous vasectomy site in the excision.

Vasectomy

Vasectomy is an excellent method of permanent contraception for the couple whose family is complete, who are mature and fully informed, and who will accept permanent sterility. It is also valuable in preventing bacterial epididymitis. Vasectomy is customarily performed in the office or clinic setting under local anesthesia. Many techniques may be used, but the cut-fulgurate-and-cover technique has never failed in my experience. Postoperative testing is mandatory, and negative results on two samples, collected one month apart, will ensure that delayed spontaneous recanalization has not occurred. The specific complications of vasectomy are spermatic granulomas of vas or epididymis, congestive epididymitis, and antisperm antibodies. Numerous studies have shown no deleterious effects upon the patient's general health. Manhood, pleasure, and sensation are unchanged, and the woman need no longer fear the possibility of an unwanted pregnancy.

A Late Post-Vasectomy Syndrome

A group of 20 surgical specimens in 18 patients with a previously unappreciated syndrome of unremitting epididymal pain and induration 5 to 7 years after vasectomy was collected during a 2-year interval. These symptoms uniformly were unresponsive to conservative measures, including empiric antibiotics. Total unilateral or bilateral epididymectomy and partial vasectomy led to complete relief of symptoms, usually within 24 hours. Pathological examination of the specimens revealed features consistent with sequelae of long-standing obstruction. Recognition of this late post-vasectomy syndrome, which represents a major complication of vasectomy, might be expected to increase as cohorts of vasectomized individuals age.

Postvasectomy Congestive Epididymitis

To the Editor.— As two of the authors of the article entitled Vasectomy and Health: Results From a Large Cohort Study, 1 we wish to clarify a statement. The article states, as expected, there was a notable excess of epididymitis-orchitis in vasectomized men. 1 We wish to point out that the majority of these were cases in which the epididymal tubule was temporarily engorged with spermatozoa and where this distention of the tubule caused discomfort. This engorgement (congestive epididymitis) is customarily a transitory condition, resolving when the balance between production and absorption of sperm has been restored. The diagnoses of orchitis and epididymitis were not specific and usually referred to swelling or tenderness of the scrotal contents.

Morbidity associated with vasectomy.

No AccessJournal of Urology1 Oct 1973Morbidity Associated With Vasectomy Julius O. Esho, Alexanders Cass, and Gerald W. Ireland Julius O. EshoJulius O. Esho More articles by this author , Alexanders CassAlexanders Cass More articles by this author , and Gerald W. IrelandGerald W. Ireland More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(17)60237-4AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail © 1973 by The American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byNANGIA A, MYLES J and THOMAS A (2018) VASECTOMY REVERSAL FOR THE POST-VASECTOMY PAIN SYNDROME: : A CLINICAL AND HISTOLOGICAL EVALUATIONJournal of Urology, VOL. 164, NO. 6, (1939-1942), Online publication date: 1-Dec-2000.Myers S, Mershon C and Fuchs E (2018) Vasectomy Reversal for Treatment of the Post-Vasectomy Pain SyndromeJournal of Urology, VOL. 157, NO. 2, (518-520), Online publication date: 1-Feb-1997.Choe J and Kirkemo A (2018) Questionnaire-Based Outcomes Study of Nononcological Post-Vasectomy ComplicationsJournal of Urology, VOL. 155, NO. 4, (1284-1286), Online publication date: 1-Apr-1996.Manson A (2018) Trial of Ibuprofen to Prevent Post-Vasectomy ComplicationsJournal of Urology, VOL. 139, NO. 5, (965-966), Online publication date: 1-May-1988.Selikowitz S and Schned A (2018) A Late Post-Vasectomy SyndromeJournal of Urology, VOL. 134, NO. 3, (494-497), Online publication date: 1-Sep-1985.Auman J (2018) Spermatic Cord Arteriovenous Fistula: An Unusual Complication of VasectomyJournal of Urology, VOL. 134, NO. 4, (768-768), Online publication date: 1-Oct-1985.Esho J and Cass A (2018) Recanalization Rate Following Methods of Vasectomy Using Interposition of Fascial Sheath of Vas DeferensJournal of Urology, VOL. 120, NO. 2, (178-179), Online publication date: 1-Aug-1978. Volume 110Issue 4October 1973Page: 413-415 Advertisement Copyright & Permissions© 1973 by The American Urological Association Education and Research, Inc.MetricsAuthor Information Julius O. Esho More articles by this author Alexanders Cass More articles by this author Gerald W. Ireland More articles by this author Expand All Advertisement PDF downloadLoading ...

An Extension of the Phase Rule for Adsorption under Equilibrium and Non-Equilibrium Conditions

An adsorption field is defined as a homogeneous part of a solid or liquid surface on which adsorption can occur. In presence of adsorbable components each field contains one or more surface phases. Adsorption experiments have demonstrated that in many cases all the intrinsic properties of an isolated surface phase are variables characterized by C+1 degrees of freedom (F) where C is the number of components. If this surface phase postulate (S.P.P.) applies to each surface phase in a system, then, for a system in a state of complete equilibrium, F has the value F0 = C+S —Pv—Ps+2 where S, Pv and Ps are the numbers of fields, volume phases and surface phases, respectively. By considering the possible mechanisms, such as interphase mobility and vapor interchange by which equilibrium may be attained, this phase rule is extended to states of partial equilibrium, for example, cases where the surface phases and the volume phases are at different temperatures. The effects of electric fields are considered. Non-equilibrium states, which may be divided into steady states and transient states are characterized by values of F greater than F0. Experiments on transients by which F can be determined may thus serve to determine S when it is otherwise unknown. If the geometrical arrangement of the surface phases is known, such experiments serve to determine the surface diffusion coefficient D, or the phase boundary resistance to diffusion. The applicability of the S.P.P. depends on a certain degree of intraphase mobility of the adatoms.