Treatment of Post vasectomy pain

[FR]

I would very much appreciate if you could please assist with the following question:

I had a vasectomy approximately 7 years ago.  Since the vasectomy I have usually had a dull pain in the testes which I have basically put up with.  However, in the last 2 or 3 months the pain has become more severe.  An incidence of a soccer ball hitting me in the groin took several days to get better.  The back and top of my testes are sensitive and painful.

I have seen two urologists so far.  After examination, they have both diagnosed that my pain is likely to be due to build up of pressure in the epididymis.

The first urologist (who does not carry out vasectomy reversals) suggested that I have my vasectomy re-done, and converted to an open ended vasectomy.  The idea being that sperm can escape from the epididymis into the scrotum thereby relieving pressure and the pain.

The second urologist (who DOES carry out vasectomy reversals) suggested that I should have my vasectomy reveresed in order to relieve the pain.  He said, that converting my vasectomy to an open ended vasectomy will only provide short term relief.  The open end of the vas will eventually close off with scar type tissue and I will be back to where I am now.

A recent ultrasound has shown the testes and epididymis to be normal.

My question is which one is correct?  In an open ended vasectomy, will the open end of the vas likely to eventually block off?  Is vasectomy reversal or an open ended vasectomy likely to bring permanant relief from testicular pain?  Which would you usually recommend?

Your response would be very much appreciated.

[Kevin Pho, MD]

There are several options to treat post-vasectomy pain.  Note that there is no "right" answer and thus, several approaches can be discussed.

One option would be a spermatic cord block. This involves your doctor injecting a small amount of a local anesthetic “numbing” medicine into the tissues surrounding the vas (the spermatic cord), high up in the scrotum.  Most of the time, this will result in almost immediate disappearance of the pain. Some times it comes back.  Other times it doesn’t.  If it does, a longer lasting block can be attempted.

Then there are the two options that you have received.  The preferred option is to have a vasectomy reversal. This is very effective, and almost always results in dramatic resolution of the pain. The down side is that you have to have a another procedure, and that you most likely will become fertile again and will have to deal with birth control.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.

[tender_nut]

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