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.

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.

• Scherger, J. E., & Ellis, A. R. (2012). Post-Vasectomy Pain Syndrome: Common but Hidden, 1–8. Retrieved from http://www.vasectomy-information.com/moreinfo/pvps.htmLiterature overview of PVPS
• Macrae, W. A. (2008). Chronic post-surgical pain: 10 years on. British Journal of Anaesthesia, 101(1), 77–86. doi:10.1093/bja/aen099
  A review article in 2003 examined the possible mechanisms in relation to changes that occur after vasectomy. It is disappointing then to find in a recent publication on sterilization the statement: ‘Whether a postvasectomy pain syndrome exists remains controversial’.
• McMahon, A. J., Buckley, J., Taylor, S., LLOYD, S. N., Deane, R. F., & D, K. (1992). Chronic Testicular Pain following Vasectomy. British Journal of Urology, (69), 188–191.
  3 out of 172 patients went for more surgery. That’s just under 2% with PVPS.
• 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.
• Tandon, S., & Sabanegh, E., Jr. (2008). Chronic pain after vasectomy: a diagnostic and treatment dilemma. BJU International, 102(2), 166–169. doi:10.1111/j.1464-410X.2008.07602.xPVPS is disappointingly common and difficult to treat. Although early pain lasting for a few weeks is fairly common after vasectomy (present in up to 30% of men), long-term pain requiring some kind of intervention or surgical therapy occurs in up to one in 1000 vasectomized men. McMahon et al. noted that although half of the patients who reported complications after surgery had long-term discomfort, there was no obvious relationship of pain with immediate haematoma or infection.
• Leslie, T. A., Illing, R. O., Cranston, D. W., & Guillebaud, J. (2007). The incidence of chronic scrotal pain after vasectomy: a prospective audit. The Elliot-Smith Clinic, The Churchill Hospital, Oxford, UK, 100(6), 1330–1333. doi:10.1111/j.1464-410X.2007.07128.xIn all, 593 (94.7%) men returned the preoperative questionnaires and were entered into the study; 488 (82.2%) of these completed the follow-up questionnaire, giving a mean (SD) follow-up of 6.8 (1.6) months. In all, 65 men reported new- onset scrotal pain at 7 months (14.7%). The mean visual analogue score for this pain was 3.4/10. Four men (0.9%) in the responding group described pain after vasectomy as ‘quite severe and noticeably affecting their quality of life’.
• Cook, L., HHAAM, V. V., LM, L., A, P., & MF, G. (2006). Vasectomy occlusion techniques for male sterilization. The Cochrane Library, (3), 1–33.Most of the studies that looked at vasectomy methods were small, not done well, or had poor reports. Therefore, we cannot say if the methods work well, are safe or are liked by men. Vasectomy with fascial interposition worked better than simply cutting and tying the vas, but the surgery was more difficult. More and better research is needed on vasectomy methods.
• Rolfes, N., & Lümmen, G. (2011). Ischämische Hodennekrose nach Vasektomie. Der Urologe, 50(10), 1306–1310. doi:10.1007/s00120-011-2634-3
  Late complications are chronic pain (0.5%-18%).
• Vasectomy and other vasal occlusion techniques for male contraception. (2012). Uptodate v19.2, 1–11.Rates for the post-vasectomy pain syndrome have been reported as 0.1 to 0.25 percent [41,42]Uptodate is a research database that HMOs, researchers and interns frequently use. The incident rates in uptodate are based on papers from 1996 and 1984, but I can’t seem to find either of them online.
• 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.

• J Urol. 2012 Feb;187(2):613-7. Epub 2011 Dec 15.
  Vasectomy reversal provides long-term pain relief for men with the post-vasectomy pain syndrome.
  Horovitz D, Tjong V, Domes T, Lo K, Grober ED, Jarvi K.

  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.

• Choe, J. M., & Kirkemo, A. K. (1996). QUESTIONNAIRE-BASED OUTCOMES STUDY OF NONONCOLOGICAL POST-VASECTOMY COMPLICATIONS. The Journal of Urology, 155, 1284–1286.Results: A total of 182 patients (42.3%) responded. Mean followup was 4.8 years. The most common complication was post-vasectomy scrotal pain in 34 men (18.7%), which adversely affected quality of life in 4 (2.2%).In retrospect, 71.4% of the men were satisfied with the decision for vasectomy, 19.3% had equivocal feelings and 9.3% were dissatisfied.
• Epididymectomy is an effective treatment for scrotal painafter vasectomy. (2000). BJU International, (85), 1097–1099.

  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.

• CHRISTIANSEN, C. G., & SANDLOW, J. I. (2003). Testicular Pain Following Vasectomy: Review A Review of Postvasectomy Pain Syndrome. Journal of Andrology, Vol 24, No 3. May/June 2003, 24(3), 293–298. Retrieved from http://www.andrologyjournal.org/cgi/content/full/24/3/293

  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.

• Manikandan, R., Srirangam, S. J., Pearson, E., & Collins, G. N. (2004). Early and late morbidity after vasectomy. BJU International, 93(4), 571–574. doi:10.1111/j.1464-410X.2004.04663.xIn group A, 25 of 180 (13.8%) had a new onset of scrotal pain of some nature, with eight (4.3%) having a VAS of >5; one patient had an epididymectomy for this.In group B, 36 of 214 (16.8%) reported persistent scrotal pain, with 13 (5.9%) having a VAS of >5.

Vasectomy Reversal research:

• NANGIA, A. K., MYLES, J. L., & THOMAS, A. J. (2000). VASECTOMY REVERSAL FOR THE POST-VASECTOMY PAIN SYNDROME: A CLINICAL AND HISTOLOGICAL EVALUATION. The Journal of Urology, 1939–1942
• CHEN, T. F., & BALL, R. Y. (1991). Epididymectomy for Post-vasectomy Pain: Histological Review. British Journal of Urology, 407–413.N=15 in this case.Epdidymectomies were performed on 10 patients. 50% were cured. So basically 5 patients. You’re joking right?
• Strom, K. H., & Levine, L. A. (2008). Microsurgical Denervation of the Spermatic Cord for Chronic Orchialgia: Long-Term Results From a Single Center. The Journal of Urology, 180(3), 949–953. doi:10.1016/j.juro.2008.05.018Microsurgical Denervation study results:Results: Mean followup was 20.3 months (range 1 to 102 months) and complete, durable relief was noted in 67 (71%) testicular units, partial relief in 17 (17%), and unchanged in 11 (12%). No patients reported worse pain. Complications included testicular atrophy without hypogonadism in 2 patients, superficial wound infection in 2, hydrocele in 2 and an incisional hematoma in 1.
• MYERS, S. A., MERSHON, C. E., & FUCHS, E. F. (1997). VASECTOMY REVERSAL FOR TREATMENT OF THE POST-VASECTOMY PAIN SYNDROME. The Journal of Urology, 157, 518–520.Results: 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.This is the paper which is cited when you see that 84% of men had relief from PVPS.