Vas Deferens Pain

I was thinking about pain in the vas deferens, can you actually feel it, is it the vas deferens that actually is hurting, etc. This brought me to an article describing the role of patency in vasectomy reversal for patients suffering from PVPS. Most guys, including me, who undergo a vasectomy reversal are hoping the reconnected plumbing will remove the back-up congestion. Thus, relieving the stress on the epididymis.

An article in the International Journal of Impotence Research in September of 2012 looked at this very issue of patency. The article is entitled, "Efficacy of vasectomy reversal according to patency for the surgical treatment of postvasectomy pain syndrome" by JY Lee, et al in Seoul, Korea.

They isolated 32 patients who underwent a vasectomy reversal for PVPS over a 10 year period. Of the 32 patients, 22 participated in the study. Patency was achieved in 68% of the men or about 15/22. The overall satisfaction with the procedure was scored categorically as follows: (a) cure, (b) improvement, (c) no change, or (d) recurrence.

There was a significant difference in this satisfaction score based on patency; those with patency reported higher satisfaction than those without patency. The authors go on to conclude that patency achievement with vasectomy reversal in PVPS patients has a direct relationship to surgical satisfaction and overall pain reduction.

So the goal for vasectomy reversal for PVPS patients should be the same as those looking to reverse their infertility, patency of sperm.

PVPS Article

I read an interesting review article from the Canadian Journal of Urology regarding post vasectomy pain: (Morley, et al. Post-vasectomy pain syndrome: clinical features and treatment options. Can J Urol 2012 Apr. 19(2):6160-4).

In it the authors from West Virginia state very clearly that there are meaningful vasectomy side effects. The purpose of the article was to review the available scientific literature from a big picture perspective on the entirety of PVPS. It starts out with a definition for post vasectomy pain syndrome as follows: a chronic epididymal pain that is continuous or recurrent in the absence of proven epididymal or testicular infection.

The authors, from the Robert C. Byrd Health Science Center at West Virginia University, state this syndrome is occurring with increased regularity, as the number of vasectomies performed in the US escalates. Their research tells us that 4,000,000 vasectomies are performed annually. That seems like a lot of sterilization surgeries to me and quite the income stream for a budding urologist.

Sadly still, nobody understands the etiology of the condition. This is what makes it so frustrating, the lack of knowledge in this area. Why does it occur? Who is at risk? At this point, all we have are working theories. With these theories come a multiple of proposed treatment modalities. This is what the article focuses on, the varied aims of treatment.

To begin with, the authors look at the surgical option. Here they include spermatic cord denervation and vasovasostomies (reversals). There is a physician in Florida who is doing some exciting work in the world of spermatic cord denervation. His goal is to not entirely strip the nerve, but rather take a more selective approach, thus preserving much of the spermatic cord. 

Regarding the reversals, technique varies greatly, as does expertise. Most people on the PVPS forum recommend seeking out a urology specialist who has performed multiple reversals for men who suffer from PVPS. 

A medical treatment mentioned in the article includes testosterone. Morley mentions "promising results" with its use. 

In the end, the article is quite clear about one thing, and I'll quote their own words, "Nevertheless, the importance of counseling patients of the risks of PVPS with vasectomy cannot be overstated."

There are two take home points to make here.

1. You'll notice this article was published in April of 2012 and is a review article. This means they have reviewed the whole of scientific literature to look specifically for relevant articles related to vasectomy side effects. So this article represents the most up to date and clear ideas associated with PVPS.

2. The authors basically echo what we've known for quite some time, that PVPS is a debilitating syndrome that has no known starting point, other than some men who undergo vasectomies end up with it. But it is not "all in your head"; this is not some made up story to express your sour grapes about having a vasectomy; and if you suffer from this, you're not alone. 

I hope to find and review more articles like this one in an effort to make this blog a little bit more about vasectomy side effects global, and transition it away from being just an online journal of symptoms. However, I will still journal as the cause and need arises.