So I promised articles from the last 20 years that indicate that the incidence of new onset, chronic pain after vasectomy is much more common than the CUA will acknowledge.
So here’s the journal articles. I’ve included all the articles I’ve curated over the last year.
To start, we’ll look at the CUA vasectomy guideline.
PVPS:
CUA Vasectomy Guideline There is no reason to believe that having a vasectomy can cause other health problems.
Vic’s Note: Apparently, the Canadian Urological Association hasn’t done much homework about vasectomy patient outcomes.
Heidelbaugh, J. J., Llanes, M., & Weadock, W. J. (2010). An algorithm for the treatmentof chronic testicular pain. The Journal of Family Practice, 59(6), 330–336.
Postvasectomy pain is not unusual.
Several years after a vasectomy, the diameter of a man’s ejaculatory ducts often doubles in size to counteract the increase in fluid pressure. The specific cause of long-term post- vasectomy pain syndrome, or congestive epididymitis, is unknown, but has been reported in 5% to 43% of men who have undergone this procedure. Sperm granulomas or spermatoceles represent the body’s effort to spare the testicle from damage secondary to increasing fluid pressure. While these granulomas are benign lesions, their presence may predispose a man to postvasectomy pain syndrome.
AHMED, I., RASHEED, S., WHITE, C., & SHAIKH, N. (1997). The incidence of post-vasectomy chronic testicular pain and the role of nerve stripping (denervation) of the spermatic cord in its management. British Journal of Urology, (79), 269–270.Results:Of 396 replies, 108 (27.2%) patients complained of some testicular pain following their vasectomy operation. In 88 (82%) of these 108 patients the pain was brief and was not defined as CPTP, while 20 (19%) patients had pain for >3 months; 33 (31%) patients required analgesics to control the pain. Of the 17 patients who underwent spermatic cord denervation, 13 reported complete relief of pain at their first follow-up visit and were discharged. Four patients had a significant improvement in the symptom score and were satisfied with the results.Conclusions: There is a small but significant incidence of CPTP and patients should be warned of this possibility when counselled before operation.Denervation of the spermatic cord seems to be a viable surgical option for patients with CPTP who fail to respond to conservative measures.
Vic’s Note: In this study, ‘small’ is defined as 17/396. This is still a 4.3% incidence rate.
Vic’s Note: Stating that you got robust results with 13 people in the sample size and especially stating that you got 93% efficacy in treatment is misleading when all you’ve done is find 13/14 patients were good.
I’m hard pressed to believe that anybody with a stats background would be willing to say that those kinds of results should be generally applicable to the general populace.
Vic’s notes: I was more interested in the occurance rates for PVPS. 560 patients. 17 came back for denervation. That’s still 3% of patients who opt for corrective surgery after vasectomy.
On the Shapiro and Silber study in 1979: “Unfortunately, long-term follow-up was not part of the study; however, the authors interpreted the results to conclude that sperm granulomas are entirely benign and their formation should be encouraged through the use of open- ended vasectomy to reduce the risk of PVPS. Another study by Moss (1992) helped confirm Shapiro and Silber’s conclusions. In this study, rates of PVPS were compared in 3081 patients with closed-ended vasectomy and 3139 patients with open-ended vasectomy. This study demonstrated that 6% of the patients with closed-ended vasectomy developed PVPS, whereas only 2% of patients with open-ended vasectomy did.
Aetna considers the implantable vas deferens ligation clip (Vasclip, VMBC, LLC, Roseville, MN) experimental and investigational for ligation of the vas deferens for male sterilization because there is insufficient evidence in the peer-reviewed literature that the Vasclip procedure provides clinically significant benefits over standard vasectomy procedures.
Vic’s Notes: This is a good example of a misquoted study. Sometimes you’ll see a reference to study of 700,000 men in the Netherlands. That never actually happened.
McCormack, M., & Lapointe, S. (1988). Physiologic consequences and complications of vasectomy. Canadian Medical Association Journal, 138(3), 223–225.
Sterilization of men and women is the most popular method of contraception in Canada. The contraceptive effect of a vasectomy usually occurs within 3 months. The production of sperm, however, is not interrupted, and an increase in pressure proximal to the ligation site may cause rupture of the epididymis or the ductus deferens, with extravasation of spermatozoa and the formation of granulomas or sperm antibodies. Increased pressure may also explain the postvasectomy pain syndrome.
New AUA Statement as of Nov 2012.Chronic scrotal pain associated with negative impact on quality of life occurs after vasectomy in about 1-2% of men. Few of these men require additional surgery.