Epididymectomy for post-vasectomy pain: histological review.

Department of Urology, Addenbrooke's Hospital, Cambridge.

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.

PIP: Epididymectomy was performed on 10 men with intractable post-vasectomy pain, on 7 with chronic epididymo-orchitis and 7 with epididymal cysts. The vasectomy patients had pain of mean 6 years duration, 6 months-20 years after surgery. In 9 the pain was a constant, dull ache. 5 had unilateral, and 5 bilateral epididymectomy. Only 5 were relieved of pain: 1 subsequently had orchidectomy with symptomatic improvement. The other 4 were offered orchidectomy. There was no obvious association of clinical findings with results. All 7 patients with epididymo-orchitis were relieved, although 1 required orchidectomy. 4 of the 7 with cysts had complained of pain, and all were asymptomatic after surgery. The most common pathological findings in the vasectomy patients were obstruction and dilatation of the efferent and epididymal ducts with interstitial fibrosis, and perineural inflammation and fibrosis around nerves, particularly in the tail of epididymis. So-called "late vasectomy syndrome" or unremitting pain is rare, and probable related to sperm granuloma.

PMID: 1933163 [PubMed - indexed for MEDLINE]