Nangia A K, Myles J L, Thomas AJ J R
Urological Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
J Urol. 2000 Dec;164(6):1939-42.
The cause of the post-vasectomy pain syndrome is unclear. Some postulated etiologies include epididymal congestion, tender sperm granuloma and/or nerve entrapment at the vasectomy site. To our knowledge nerve proliferation has not been evaluated previously as a cause of pain. Vasectomy reversal is reportedly successful for relieving pain in some patients. We report our experience and correlate histological findings in resected vasal segments with outcome to explain the mechanism of pain in these patients.
We retrospectively reviewed the records of 13 men who underwent vasectomy reversal for the post-vasectomy pain syndrome. We compared blinded histological evaluations of the vasal ends excised at vasectomy reversal in these patients with those of pain-free controls who underwent vasectomy reversal to reestablish fertility. Controls were matched to patients for the interval since vasectomy. Histological features were graded according to the degree of severity of vasitis nodosum, chronic inflammation and nerve proliferation.
Mean time to pain onset after vasectomy was 2 years. Presenting symptoms included testicular pain in 9 cases, epididymal pain in 2, pain at ejaculation in 4 and pain during intercourse in 8. Physical examination demonstrated tender epididymides in 6 men, full epididymides in 6, a tender vasectomy site in 4 and a palpable nodule in 4. No patient had testicular tenderness on palpation. Unilateral and bilateral vasovasostomy was performed in 3 and 10 of the 13 patients, respectively. Postoperatively 9 of the 13 men (69%) became completely pain-free. Mean followup was 1.5 years. We observed no differences in vasectomy site histological features in patients with the post-vasectomy pain syndrome and matched controls, and no difference in histological findings in patients with the post-vasectomy pain syndrome who did and did not become pain-free postoperatively.
No histological features aid in identifying a cause of pain or provide prognostic value for subsequent pain relief. Vasectomy reversal appeared to be beneficial for relieving pain in the majority of select patients with the post-vasectomy pain syndrome.
输精管结扎术后疼痛综合征的病因尚不清楚。一些推测的病因包括附睾充血、疼痛性精子肉芽肿和/或输精管结扎部位的神经受压。据我们所知，神经增生此前尚未被评估为疼痛的原因。据报道，输精管复通术对部分患者缓解疼痛有效。我们报告我们的经验，并将切除的输精管段的组织学发现与结果相关联，以解释这些患者疼痛的机制。
我们回顾性分析了13例因输精管结扎术后疼痛综合征而行输精管复通术的男性患者的记录。我们将这些患者输精管复通时切除的输精管断端的组织学评估结果与因恢复生育而行输精管复通术的无痛对照组进行了比较。对照组与患者输精管结扎后的时间间隔相匹配。根据结节性输精管炎、慢性炎症和神经增生的严重程度对组织学特征进行分级。
输精管结扎术后疼痛开始的平均时间为2年。主要症状包括9例睾丸疼痛、2例附睾疼痛、4例射精疼痛和8例性交疼痛。体格检查发现6例男性附睾压痛、6例附睾饱满、4例输精管结扎部位压痛、4例可触及结节。触诊时所有患者均无睾丸压痛。13例患者中，3例行单侧输精管吻合术，10例行双侧输精管吻合术。术后13例患者中有9例（69%）完全无痛。平均随访时间为1.5年。我们观察到输精管结扎术后疼痛综合征患者与匹配对照组在输精管结扎部位的组织学特征上没有差异，术后疼痛缓解和未缓解的输精管结扎术后疼痛综合征患者在组织学发现上也没有差异。
没有组织学特征有助于确定疼痛原因或为后续疼痛缓解提供预后价值。输精管复通术似乎对大多数选定患有输精管结扎术后疼痛综合征的患者缓解疼痛有益。
