Materiały źródłowe

• #1 Post-vasectomy pain syndrome: diagnosis, management and treatment options

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5503923/

  Vasectomy is the most effective form of sterilization for men. With approximately 500,000 vasectomies performed each year in the United States, 12% of these patients will experience chronic testicular pain for greater than three months after the procedure. Post-vasectomy pain syndrome (PVPS) is diagnosis of exclusion, and may be caused by direct damage to spermatic cord structures, compression of nerves in the spermatic cord via inflammation, back pressure from epididymal congestion, and perineural fibrosis. […] Following vasectomy, a small fraction of patients experience chronic pain. Post-vasectomy pain syndrome (PVPS) is widely known as either constant or intermittent testicular pain for greater than three months. This pain interferes with quality of life and requires some degree of medical treatment in approximately 12% of men who undergo vasectomy.

• #2 Post-vasectomy pain syndrome: diagnosis, management and treatment options – Sinha – Translational Andrology and Urology

  https://tau.amegroups.org/article/view/15005/15152

  Post-vasectomy pain syndrome (PVPS) is diagnosis of exclusion, and may be caused by direct damage to spermatic cord structures, compression of nerves in the spermatic cord via inflammation, back pressure from epididymal congestion, and perineural fibrosis. […] Post-vasectomy pain syndrome (PVPS) is widely known as either constant or intermittent testicular pain for greater than three months. […] The most common symptom of PVPS is persistent orchalgia greater than three months after surgery, however, some patients present with pain with ejaculation, intercourse or erection. […] Ultimately, the diagnosis of PVPS is most safely made as a diagnosis of exclusion. […] A thorough history and physical is required at least three months after surgery. […] With a detailed history and physical exam serially for several months following vasectomy, a diagnosis of PVPS can be safely made. […] Thus, a comprehensive evaluation is warranted to best establish a diagnosis in patients with chronic testicular pain.

• #3 Post-vasectomy pain syndrome: diagnosis, management and treatment options – PubMed

  https://pubmed.ncbi.nlm.nih.gov/28725617/

  Vasectomy is the most effective form of sterilization for men. With approximately 500,000 vasectomies performed each year in the United States, 1-2% of these patients will experience chronic testicular pain for greater than three months after the procedure. Post-vasectomy pain syndrome (PVPS) is diagnosis of exclusion, and may be caused by direct damage to spermatic cord structures, compression of nerves in the spermatic cord via inflammation, back pressure from epididymal congestion, and perineural fibrosis. Treatment should begin with the most noninvasive options and progress towards surgical management if symptoms persist. Noninvasive therapies include acupuncture, pelvic floor therapy and pharmacologic options. Ultimately, management of PVPS requires a multimodal approach. Thorough understanding of the potential etiologies of PVPS along with the therapeutic options currently available is important to improve quality of life.

• #4 Post-vasectomy pain syndrome: diagnosis, management and treatment options

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5503923/

  Vasectomy is the most effective form of sterilization for men. With approximately 500,000 vasectomies performed each year in the United States, 12% of these patients will experience chronic testicular pain for greater than three months after the procedure. Post-vasectomy pain syndrome (PVPS) is diagnosis of exclusion, and may be caused by direct damage to spermatic cord structures, compression of nerves in the spermatic cord via inflammation, back pressure from epididymal congestion, and perineural fibrosis. […] Following vasectomy, a small fraction of patients experience chronic pain. Post-vasectomy pain syndrome (PVPS) is widely known as either constant or intermittent testicular pain for greater than three months. This pain interferes with quality of life and requires some degree of medical treatment in approximately 12% of men who undergo vasectomy.

• #5 Incidence of Post-Vasectomy Pain: Systematic Review and Meta-Analysis

  https://www.mdpi.com/1660-4601/17/5/1788

  This is the first systematic review and meta-analysis to ascertain incidences of post-vasectomy pain following traditional scalpel, or non-scalpel vasectomy. […] Post-vasectomy pain syndrome (PVPS), also known as chronic post-vasectomy pain, is formally defined as an intermittent or constant unilateral or bilateral testicular pain three months or longer in duration which significantly interferes with daily activities of the patient so as to prompt him to seek medical attention. […] Chronic pain following vasectomy is very challenging to diagnose and treat. Being a diagnosis of exclusion, it exposes the patient to a series of investigations and treatment regimens over months. […] Although chronic post-vasectomy pain is a recognized complication, current literature shows lack of consensus regarding its frequency. Recent narrative reviews report the incidence of post-vasectomy pain to be between 1% and 6%.

• #6 Incidence of Post-Vasectomy Pain: Systematic Review and Meta-Analysis

  https://www.mdpi.com/1660-4601/17/5/1788

  The overall incidence of post-vasectomy pain was 15% (95% CI 9% to 25%), with a higher incidence of 24% (95% CI 15% to 36%) for traditional scalpel vasectomy compared to 7% (95% CI 4% to 13%) for NSV. […] The incidence of PVPS was similar for scalpel vasectomy (5% [95% CI 4% to 6%]) and NSV (5% [95% CI 1% to 18%]). […] The results of our systematic review and meta-analysis indicate that the incidence of post-vasectomy pain is higher than previously reported estimates. Following traditional scalpel vasectomy, the incidence of post-vasectomy pain is more than three-fold higher than after NSV. However, the incidence of PVPS is similar between the two techniques.

• #7 Post-vasectomy pain syndrome: diagnosis, management and treatment options

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5503923/

  It is crucial to differentiate acute post-operative pain from PVPS. The most common symptom of PVPS is persistent orchalgia greater than three months after surgery, however, some patients present with pain with ejaculation, intercourse or erection. […] Ultimately, the diagnosis of PVPS is most safely made as a diagnosis of exclusion. A thorough history and physical is required at least three months after surgery. All patients with chronic testicular pain should undergo scrotal ultrasound with Doppler color-flow. […] Management of PVPS can be frustrating for both the clinician and the patient. Treatment should begin with the most noninvasive options and progress towards surgical management if symptoms persist. […] Surgical options include excision of sperm granuloma, microdenervation of spermatic cord, epididymectomy, vasovasostomy and in severe cases, orchiectomy.

• #8 Post-vasectomy pain syndrome: diagnosis, management and treatment options – Sinha – Translational Andrology and Urology

  https://tau.amegroups.org/article/view/15005/15152

  Post-vasectomy pain syndrome (PVPS) is diagnosis of exclusion, and may be caused by direct damage to spermatic cord structures, compression of nerves in the spermatic cord via inflammation, back pressure from epididymal congestion, and perineural fibrosis. […] Post-vasectomy pain syndrome (PVPS) is widely known as either constant or intermittent testicular pain for greater than three months. […] The most common symptom of PVPS is persistent orchalgia greater than three months after surgery, however, some patients present with pain with ejaculation, intercourse or erection. […] Ultimately, the diagnosis of PVPS is most safely made as a diagnosis of exclusion. […] A thorough history and physical is required at least three months after surgery. […] With a detailed history and physical exam serially for several months following vasectomy, a diagnosis of PVPS can be safely made. […] Thus, a comprehensive evaluation is warranted to best establish a diagnosis in patients with chronic testicular pain.

• #9 Post-vasectomy pain syndrome – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/post-vasectomy-pain-syndrome/diagnosis-treatment/drc-20527109

  Your provider will conduct a thorough physical exam, checking for tenderness and swelling of the testicles and epididymis. Your provider will also look for the presence of a small ball of scar tissue where your vasectomy was performed (sperm granuloma). […] Other possible causes of testicle pain will need to be ruled out. Tests your provider might recommend include: […] Sexually transmitted infections (STI) screening. A narrow swab is inserted into the end of your penis to obtain a sample of discharge from your urethra. The sample is checked in the lab for STIs such as gonorrhea and chlamydia. […] Urine and blood tests. Samples of your urine and blood are analyzed for infection and any other unusual findings. […] Ultrasound. This is an imaging method that uses high-frequency sound waves to produce images of structures inside your body. Ultrasound might be used to rule out a rotation of a testicle, which twists the spermatic cord that brings blood to the scrotum (testicular torsion); a cyst that develops in the epididymis (spermatocele); infections of the testicle or epididymis; or a hernia.

• #10 Post-vasectomy pain syndrome | UM Health-Sparrow

  https://www.uofmhealthsparrow.org/departments-conditions/conditions/post-vasectomy-pain-syndrome

  Your provider will conduct a thorough physical exam, checking for tenderness and swelling of the testicles and epididymis. Your provider will also look for the presence of a small ball of scar tissue where your vasectomy was performed (sperm granuloma). […] Other possible causes of testicle pain will need to be ruled out. Tests your provider might recommend include: […] Ultrasound might be used to rule out a rotation of a testicle, which twists the spermatic cord that brings blood to the scrotum (testicular torsion); a cyst that develops in the epididymis (spermatocele); infections of the testicle or epididymis; or a hernia. […] MRI may be used to evaluate the spine or hips in men with a history of back or hip problems to rule out nerve compression.

• #11 Post-vasectomy pain syndrome: diagnosis, management and treatment options – Sinha – Translational Andrology and Urology

  https://tau.amegroups.org/article/view/15005/html

  Post-vasectomy pain syndrome (PVPS) is diagnosis of exclusion, and may be caused by direct damage to spermatic cord structures, compression of nerves in the spermatic cord via inflammation, back pressure from epididymal congestion, and perineural fibrosis. […] Post-vasectomy pain syndrome (PVPS) is widely known as either constant or intermittent testicular pain for greater than three months. […] The most common symptom of PVPS is persistent orchalgia greater than three months after surgery, however, some patients present with pain with ejaculation, intercourse or erection. […] Ultimately, the diagnosis of PVPS is most safely made as a diagnosis of exclusion. […] A thorough history and physical is required at least three months after surgery. […] With a detailed history and physical exam serially for several months following vasectomy, a diagnosis of PVPS can be safely made.

• #12 Post-vasectomy pain syndrome: diagnosis, management and treatment options – Sinha – Translational Andrology and Urology

  https://tau.amegroups.org/article/view/15005/html

  Post-vasectomy pain syndrome (PVPS) is diagnosis of exclusion, and may be caused by direct damage to spermatic cord structures, compression of nerves in the spermatic cord via inflammation, back pressure from epididymal congestion, and perineural fibrosis. […] Post-vasectomy pain syndrome (PVPS) is widely known as either constant or intermittent testicular pain for greater than three months. […] The most common symptom of PVPS is persistent orchalgia greater than three months after surgery, however, some patients present with pain with ejaculation, intercourse or erection. […] Ultimately, the diagnosis of PVPS is most safely made as a diagnosis of exclusion. […] A thorough history and physical is required at least three months after surgery. […] With a detailed history and physical exam serially for several months following vasectomy, a diagnosis of PVPS can be safely made.

• #13 Post-vasectomy pain syndrome: diagnosis, management and treatment options

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5503923/

  It is crucial to differentiate acute post-operative pain from PVPS. The most common symptom of PVPS is persistent orchalgia greater than three months after surgery, however, some patients present with pain with ejaculation, intercourse or erection. […] Ultimately, the diagnosis of PVPS is most safely made as a diagnosis of exclusion. A thorough history and physical is required at least three months after surgery. All patients with chronic testicular pain should undergo scrotal ultrasound with Doppler color-flow. […] Management of PVPS can be frustrating for both the clinician and the patient. Treatment should begin with the most noninvasive options and progress towards surgical management if symptoms persist. […] Surgical options include excision of sperm granuloma, microdenervation of spermatic cord, epididymectomy, vasovasostomy and in severe cases, orchiectomy.

• #14 Post-Vasectomy Pain Syndrome: Symptoms, Causes, and Treatment

  https://www.healthline.com/health/post-vasectomy-pain-syndrome

  Post-vasectomy pain syndrome (PVPS) is a complication of a vasectomy where you experience long-term testicular pain. […] PVPS is an uncommon complication where chronic pain develops for longer than 3 months after a vasectomy. […] To receive a PVPS diagnosis, you need to have constant pain in one or both testicles for 3 months or longer that significantly interferes with daily activities. […] No particular tests are needed to diagnose PVPS. Your doctor will likely diagnose PVPS by reviewing your medical history, asking you about your symptoms, and performing a physical exam. […] You may also receive urine tests or a semen culture to rule out infections. In some cases, your doctor may want to order an ultrasound to see the inner structure of your testicles and vas deferens.

• #15 Post-vasectomy pain syndrome – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/post-vasectomy-pain-syndrome/diagnosis-treatment/drc-20527109

  Your provider will conduct a thorough physical exam, checking for tenderness and swelling of the testicles and epididymis. Your provider will also look for the presence of a small ball of scar tissue where your vasectomy was performed (sperm granuloma). […] Other possible causes of testicle pain will need to be ruled out. Tests your provider might recommend include: […] Sexually transmitted infections (STI) screening. A narrow swab is inserted into the end of your penis to obtain a sample of discharge from your urethra. The sample is checked in the lab for STIs such as gonorrhea and chlamydia. […] Urine and blood tests. Samples of your urine and blood are analyzed for infection and any other unusual findings. […] Ultrasound. This is an imaging method that uses high-frequency sound waves to produce images of structures inside your body. Ultrasound might be used to rule out a rotation of a testicle, which twists the spermatic cord that brings blood to the scrotum (testicular torsion); a cyst that develops in the epididymis (spermatocele); infections of the testicle or epididymis; or a hernia.

• #16 Post-vasectomy pain syndrome | Altru Health System

  https://www.altru.org/health-library/conditions/post-vasectomy-pain-syndrome

  Your provider will conduct a thorough physical exam, checking for tenderness and swelling of the testicles and epididymis. Your provider will also look for the presence of a small ball of scar tissue where your vasectomy was performed (sperm granuloma). […] Other possible causes of testicle pain will need to be ruled out. Tests your provider might recommend include: […] Sexually transmitted infections (STI) screening. A narrow swab is inserted into the end of your penis to obtain a sample of discharge from your urethra. The sample is checked in the lab for STIs such as gonorrhea and chlamydia. […] Urine and blood tests. Samples of your urine and blood are analyzed for infection and any other unusual findings. […] Ultrasound. This is an imaging method that uses high-frequency sound waves to produce images of structures inside your body. Ultrasound might be used to rule out a rotation of a testicle, which twists the spermatic cord that brings blood to the scrotum (testicular torsion); a cyst that develops in the epididymis (spermatocele); infections of the testicle or epididymis; or a hernia. […] Magnetic resonance imaging (MRI). An MRI scan uses a powerful magnet and radio waves to produce detailed images of structures inside your body. MRI may be used to evaluate the spine or hips in men with a history of back or hip problems to rule out nerve compression.

• #17 Post-vasectomy pain syndrome – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/post-vasectomy-pain-syndrome/diagnosis-treatment/drc-20527109

  Your provider will conduct a thorough physical exam, checking for tenderness and swelling of the testicles and epididymis. Your provider will also look for the presence of a small ball of scar tissue where your vasectomy was performed (sperm granuloma). […] Other possible causes of testicle pain will need to be ruled out. Tests your provider might recommend include: […] Sexually transmitted infections (STI) screening. A narrow swab is inserted into the end of your penis to obtain a sample of discharge from your urethra. The sample is checked in the lab for STIs such as gonorrhea and chlamydia. […] Urine and blood tests. Samples of your urine and blood are analyzed for infection and any other unusual findings. […] Ultrasound. This is an imaging method that uses high-frequency sound waves to produce images of structures inside your body. Ultrasound might be used to rule out a rotation of a testicle, which twists the spermatic cord that brings blood to the scrotum (testicular torsion); a cyst that develops in the epididymis (spermatocele); infections of the testicle or epididymis; or a hernia.

• #18 Post-Vasectomy Pain Syndrome: Causes, Symptoms, Risk Factors, Diagnosis, Treatment, Prevention and Complications

  https://www.prepladder.com/neet-pg-study-material/obstetrics-and-gynaecology/post-vasectomy-pain-syndrome-causes-symptoms-risk-factors-diagnosis-treatment-prevention-and-complications

  Your doctor will perform a thorough physical examination and check for discomfort and edema in the testicles and epididymis. Furthermore, the physician attending to you will examine the area of your vasectomy for the presence of a little ball-shaped growth known as a sperm granuloma. […] It will be required to rule out alternative causes of testicular pain. Your provider could advise doing the following tests: […] STI (sexually transmitted infection) screening: You insert a small swab into the tip of your penis to obtain a sample of the discharge from your urethra. STIs like gonorrhea and chlamydia are checked for at the laboratory on the sample. […] Tests using urine and blood: We check samples of your blood and urine for abnormalities and infections. […] Ultrasound: Using high-frequency sound waves, this imaging method produces images of the inside body architecture. Ultrasound imaging can rule out spermatocele, an epididymal cyst, infections of the testicles or epididymis, and hernias. Testicular torsion is a rotation of the testicles that bends the spermatic cord carrying blood to the scrotum. […] Magnetic resonance imaging is referred to as MRI: An MRI scan uses a powerful magnet and radio waves to provide exact images of your body’s inside organs. Men who have a history of hip or back problems can think about getting an MRI to examine their hips or spine and rule out nerve compression.

• #19 Post-vasectomy pain syndrome – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/post-vasectomy-pain-syndrome/diagnosis-treatment/drc-20527109

  Your provider will conduct a thorough physical exam, checking for tenderness and swelling of the testicles and epididymis. Your provider will also look for the presence of a small ball of scar tissue where your vasectomy was performed (sperm granuloma). […] Other possible causes of testicle pain will need to be ruled out. Tests your provider might recommend include: […] Sexually transmitted infections (STI) screening. A narrow swab is inserted into the end of your penis to obtain a sample of discharge from your urethra. The sample is checked in the lab for STIs such as gonorrhea and chlamydia. […] Urine and blood tests. Samples of your urine and blood are analyzed for infection and any other unusual findings. […] Ultrasound. This is an imaging method that uses high-frequency sound waves to produce images of structures inside your body. Ultrasound might be used to rule out a rotation of a testicle, which twists the spermatic cord that brings blood to the scrotum (testicular torsion); a cyst that develops in the epididymis (spermatocele); infections of the testicle or epididymis; or a hernia.

• #20 Post-Vasectomy Pain Syndrome: Causes, Symptoms, Risk Factors, Diagnosis, Treatment, Prevention and Complications

  https://www.prepladder.com/neet-pg-study-material/obstetrics-and-gynaecology/post-vasectomy-pain-syndrome-causes-symptoms-risk-factors-diagnosis-treatment-prevention-and-complications

  Your doctor will perform a thorough physical examination and check for discomfort and edema in the testicles and epididymis. Furthermore, the physician attending to you will examine the area of your vasectomy for the presence of a little ball-shaped growth known as a sperm granuloma. […] It will be required to rule out alternative causes of testicular pain. Your provider could advise doing the following tests: […] STI (sexually transmitted infection) screening: You insert a small swab into the tip of your penis to obtain a sample of the discharge from your urethra. STIs like gonorrhea and chlamydia are checked for at the laboratory on the sample. […] Tests using urine and blood: We check samples of your blood and urine for abnormalities and infections. […] Ultrasound: Using high-frequency sound waves, this imaging method produces images of the inside body architecture. Ultrasound imaging can rule out spermatocele, an epididymal cyst, infections of the testicles or epididymis, and hernias. Testicular torsion is a rotation of the testicles that bends the spermatic cord carrying blood to the scrotum. […] Magnetic resonance imaging is referred to as MRI: An MRI scan uses a powerful magnet and radio waves to provide exact images of your body’s inside organs. Men who have a history of hip or back problems can think about getting an MRI to examine their hips or spine and rule out nerve compression.

• #21 Post-vasectomy pain syndrome – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/post-vasectomy-pain-syndrome/diagnosis-treatment/drc-20527109

  Magnetic resonance imaging (MRI). An MRI scan uses a powerful magnet and radio waves to produce detailed images of structures inside your body. MRI may be used to evaluate the spine or hips in men with a history of back or hip problems to rule out nerve compression. […] Treatment for PVPS depends on your symptoms and how much pain you have. […] Your provider may consider a tricyclic antidepressant or an anticonvulsant. These drugs can be helpful in treating nerve pain, although they have not been studied extensively in men with PVPS. […] Your provider may suggest a nerve block, which uses numbing medication to target the nerve that goes to the testicle. This will probably only temporarily relieve your discomfort. Pain often returns once the numbing medication wears off. […] In this procedure, the surgeon separates nerves and veins that go to the testicle from other parts of the spermatic cord to reduce or eliminate pain signals. MDSC appears to be most effective in men who experience temporary relief from a cord block. When successful, MDSC can significantly improve quality of life.

• #22 Post-vasectomy pain syndrome | UM Health-Sparrow

  https://www.uofmhealthsparrow.org/departments-conditions/conditions/post-vasectomy-pain-syndrome

  Your provider will conduct a thorough physical exam, checking for tenderness and swelling of the testicles and epididymis. Your provider will also look for the presence of a small ball of scar tissue where your vasectomy was performed (sperm granuloma). […] Other possible causes of testicle pain will need to be ruled out. Tests your provider might recommend include: […] Ultrasound might be used to rule out a rotation of a testicle, which twists the spermatic cord that brings blood to the scrotum (testicular torsion); a cyst that develops in the epididymis (spermatocele); infections of the testicle or epididymis; or a hernia. […] MRI may be used to evaluate the spine or hips in men with a history of back or hip problems to rule out nerve compression.

• #23

  https://www.kuh.ku.edu.tr/mayo-clinic-care-network/mayo-clinic-health-information-library/diseases-conditions/post-vasectomy-pain-syndrome

  Other possible causes of testicle pain will need to be ruled out. Tests your provider might recommend include: […] Sexually transmitted infections (STI) screening. A narrow swab is inserted into the end of your penis to obtain a sample of discharge from your urethra. The sample is checked in the lab for STIs such as gonorrhea and chlamydia. […] Urine and blood tests. Samples of your urine and blood are analyzed for infection and any other unusual findings. […] Ultrasound. This is an imaging method that uses high-frequency sound waves to produce images of structures inside your body. Ultrasound might be used to rule out a rotation of a testicle, which twists the spermatic cord that brings blood to the scrotum (testicular torsion); a cyst that develops in the epididymis (spermatocele); infections of the testicle or epididymis; or a hernia. […] Magnetic resonance imaging (MRI). An MRI scan uses a powerful magnet and radio waves to produce detailed images of structures inside your body. MRI may be used to evaluate the spine or hips in men with a history of back or hip problems to rule out nerve compression.

• #24 Post-vasectomy pain syndrome: diagnosis, management and treatment options – Sinha – Translational Andrology and Urology

  https://tau.amegroups.org/article/view/15005/html

  A spermatic cord block may be performed to isolate the scrotum as the origin for pain. […] Thus, a comprehensive evaluation is warranted to best establish a diagnosis in patients with chronic testicular pain. […] Management of PVPS can be frustrating for both the clinician and the patient. […] Treatment should begin with the most noninvasive options and progress towards surgical management if symptoms persist. […] Surgical options include excision of sperm granuloma, microdenervation of spermatic cord, epididymectomy, vasovasostomy and in severe cases, orchiectomy. […] Microdenervation of the spermatic cord (MDSC) is the precise transection of all nerves within the spermatic cord. […] Patients who had effective temporary relief with spermatic cord block predicted a successful MDSC.

• #25 Post vasectomy recovery, scrotal swelling and testicular discomfort

  https://www.vasectomy-information.com/topic/post-vasectomy-recovery-scrotal-swelling-and-testicular-discomfort/

  Pain in the scrotum after a vasectomy can present in various ways. Persistent pain for 5-8 weeks is uncommon. A trial of conservative methods should always be the first line of therapy. Usually, a one week course of anti-inflammatory medication is inadequate treatment. Patients benefit more from a prolonged course of 4-6 weeks of daily therapy. […] One of the diagnostic tests for post vasectomy pain is a spermatic cord anesthetic (block) to insure that the pain is truly originating from the testicle/epididymis. If this is the case, and conservative treatment options have been exhausted, then one should consider some type of surgical treatment option. […] Nerve damage during the vasectomy is always a possibility. However, damaging the nerves that innervate the testicle or epididymis usually results in paresthesias (lack of sensation) in the end organ.

• #26 Post-vasectomy pain syndrome: diagnosis, management and treatment options – Sinha – Translational Andrology and Urology

  https://tau.amegroups.org/article/view/15005/html

  A spermatic cord block may be performed to isolate the scrotum as the origin for pain. […] Thus, a comprehensive evaluation is warranted to best establish a diagnosis in patients with chronic testicular pain. […] Management of PVPS can be frustrating for both the clinician and the patient. […] Treatment should begin with the most noninvasive options and progress towards surgical management if symptoms persist. […] Surgical options include excision of sperm granuloma, microdenervation of spermatic cord, epididymectomy, vasovasostomy and in severe cases, orchiectomy. […] Microdenervation of the spermatic cord (MDSC) is the precise transection of all nerves within the spermatic cord. […] Patients who had effective temporary relief with spermatic cord block predicted a successful MDSC.

• #27

  https://journals.lww.com/ajandrology/fulltext/2016/18030/an_overview_of_the_management_of_post_vasectomy.2.aspx

  Post-vasectomy pain syndrome remains one of the more challenging urological problems to manage. This can be a frustrating process for both the patient and clinician as there is no well-recognized diagnostic regimen or reliable effective treatment. […] Post-vasectomy pain syndrome is defined as at least 3 months of chronic or intermittent scrotal content pain. […] PVPS is defined as constant or intermittent testicular pain for 3 months or longer with a severity that interferes with daily activities prompting the patient to seek medical treatment. […] The evaluation includes a thorough history and physical examination. […] PVPS is a diagnosis of exclusion and the diagnosis should only be made after all these investigative studies have been performed. […] Currently, there are no published data with good evidence regarding non-surgical intervention for PVPS.

• #28 Post Vasectomy Pain Syndrome — How Long Does PVPS Last?

  https://clarewellclinics.co.uk/family-planning/vasectomy/post-vasectomy-pain-syndrome/

  Treatment options will depend on the root cause of PVPS and how severe the pain is. Treatment should initially begin with non-invasive methods such as medication to ease your discomfort. […] If your PVPS is caused by something that can be removed or fixed by surgery, you may be offered this option as a last resort if other methods have failed. […] Your clinician will conduct a physical examination to check for tenderness, swelling, and any signs of scarring. Your clinician may also suggest having an STI test to rule out other potential causes of pain and discomfort. […] Epididymitis may be mistaken for PVPS. Epididymitis occurs when the epididymis (the tube that is connected to each of the testicles) becomes swollen and painful. It is often caused by an infection, and can therefore mimic the symptoms of PVPS.

• #29 Post-vasectomy pain syndrome – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/post-vasectomy-pain-syndrome/diagnosis-treatment/drc-20527109

  Your provider will conduct a thorough physical exam, checking for tenderness and swelling of the testicles and epididymis. Your provider will also look for the presence of a small ball of scar tissue where your vasectomy was performed (sperm granuloma). […] Other possible causes of testicle pain will need to be ruled out. Tests your provider might recommend include: […] Sexually transmitted infections (STI) screening. A narrow swab is inserted into the end of your penis to obtain a sample of discharge from your urethra. The sample is checked in the lab for STIs such as gonorrhea and chlamydia. […] Urine and blood tests. Samples of your urine and blood are analyzed for infection and any other unusual findings. […] Ultrasound. This is an imaging method that uses high-frequency sound waves to produce images of structures inside your body. Ultrasound might be used to rule out a rotation of a testicle, which twists the spermatic cord that brings blood to the scrotum (testicular torsion); a cyst that develops in the epididymis (spermatocele); infections of the testicle or epididymis; or a hernia.

• #30 Post-vasectomy pain syndrome – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/post-vasectomy-pain-syndrome/diagnosis-treatment/drc-20527109

  Your provider will conduct a thorough physical exam, checking for tenderness and swelling of the testicles and epididymis. Your provider will also look for the presence of a small ball of scar tissue where your vasectomy was performed (sperm granuloma). […] Other possible causes of testicle pain will need to be ruled out. Tests your provider might recommend include: […] Sexually transmitted infections (STI) screening. A narrow swab is inserted into the end of your penis to obtain a sample of discharge from your urethra. The sample is checked in the lab for STIs such as gonorrhea and chlamydia. […] Urine and blood tests. Samples of your urine and blood are analyzed for infection and any other unusual findings. […] Ultrasound. This is an imaging method that uses high-frequency sound waves to produce images of structures inside your body. Ultrasound might be used to rule out a rotation of a testicle, which twists the spermatic cord that brings blood to the scrotum (testicular torsion); a cyst that develops in the epididymis (spermatocele); infections of the testicle or epididymis; or a hernia.

• #31 Post-vasectomy pain syndrome – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/post-vasectomy-pain-syndrome/diagnosis-treatment/drc-20527109

  Your provider will conduct a thorough physical exam, checking for tenderness and swelling of the testicles and epididymis. Your provider will also look for the presence of a small ball of scar tissue where your vasectomy was performed (sperm granuloma). […] Other possible causes of testicle pain will need to be ruled out. Tests your provider might recommend include: […] Sexually transmitted infections (STI) screening. A narrow swab is inserted into the end of your penis to obtain a sample of discharge from your urethra. The sample is checked in the lab for STIs such as gonorrhea and chlamydia. […] Urine and blood tests. Samples of your urine and blood are analyzed for infection and any other unusual findings. […] Ultrasound. This is an imaging method that uses high-frequency sound waves to produce images of structures inside your body. Ultrasound might be used to rule out a rotation of a testicle, which twists the spermatic cord that brings blood to the scrotum (testicular torsion); a cyst that develops in the epididymis (spermatocele); infections of the testicle or epididymis; or a hernia.

• #32 Post-vasectomy pain syndrome – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/post-vasectomy-pain-syndrome/diagnosis-treatment/drc-20527109

  Your provider will conduct a thorough physical exam, checking for tenderness and swelling of the testicles and epididymis. Your provider will also look for the presence of a small ball of scar tissue where your vasectomy was performed (sperm granuloma). […] Other possible causes of testicle pain will need to be ruled out. Tests your provider might recommend include: […] Sexually transmitted infections (STI) screening. A narrow swab is inserted into the end of your penis to obtain a sample of discharge from your urethra. The sample is checked in the lab for STIs such as gonorrhea and chlamydia. […] Urine and blood tests. Samples of your urine and blood are analyzed for infection and any other unusual findings. […] Ultrasound. This is an imaging method that uses high-frequency sound waves to produce images of structures inside your body. Ultrasound might be used to rule out a rotation of a testicle, which twists the spermatic cord that brings blood to the scrotum (testicular torsion); a cyst that develops in the epididymis (spermatocele); infections of the testicle or epididymis; or a hernia.

• #33 Osteopathic Manipulative Treatment as a Novel Way to Manage Postvasectomy Pain Syndrome

  https://www.degruyterbrill.com/document/doi/10.7556/jaoa.2018.162/html?lang=en&srsltid=AfmBOopPb-IUA18V-eU0VP087zj3ctPAZB2yO6afaBDR-vX-Qyf-lI7O

  We found no studies or reports of OMT use for the management of PVPS. […] The differential diagnosis for chronic testicular pain after vasectomy is broad and includes epididymitis, infection, psychogenic pain, local neuropathy, nerve impingement, and referred pain; pelvic floor dysfunction (muscle dysfunction or myofascial trigger points) is infrequently considered. […] Pelvic floor dysfunction is a cause of chronic pelvic pain syndrome (CPPS), which has not been commonly associated with vasectomy, if at all. […] Although pelvic floor physical therapy was unsuccessful in our patient, OMT was better able to target his suspected pelvic floor dysfunction, as well as somatic dysfunction in his lumbar spine, pelvis, and abdominal musculature. […] Given the heterogeneity of PVPS and the unknown prevalence of pelvic floor dysfunction as the source of chronic pain after vasectomy, an evaluation by an osteopathic physician to assess and treat the pelvic floor and surrounding structures may be useful for symptoms refractory to more traditional treatments.

• #34 Osteopathic Manipulative Treatment as a Novel Way to Manage Postvasectomy Pain Syndrome

  https://www.degruyterbrill.com/document/doi/10.7556/jaoa.2018.162/html?lang=en&srsltid=AfmBOopPb-IUA18V-eU0VP087zj3ctPAZB2yO6afaBDR-vX-Qyf-lI7O

  We found no studies or reports of OMT use for the management of PVPS. […] The differential diagnosis for chronic testicular pain after vasectomy is broad and includes epididymitis, infection, psychogenic pain, local neuropathy, nerve impingement, and referred pain; pelvic floor dysfunction (muscle dysfunction or myofascial trigger points) is infrequently considered. […] Pelvic floor dysfunction is a cause of chronic pelvic pain syndrome (CPPS), which has not been commonly associated with vasectomy, if at all. […] Although pelvic floor physical therapy was unsuccessful in our patient, OMT was better able to target his suspected pelvic floor dysfunction, as well as somatic dysfunction in his lumbar spine, pelvis, and abdominal musculature. […] Given the heterogeneity of PVPS and the unknown prevalence of pelvic floor dysfunction as the source of chronic pain after vasectomy, an evaluation by an osteopathic physician to assess and treat the pelvic floor and surrounding structures may be useful for symptoms refractory to more traditional treatments.

• #35 Osteopathic Manipulative Treatment as a Novel Way to Manage Postvasectomy Pain Syndrome

  https://www.degruyterbrill.com/document/doi/10.7556/jaoa.2018.162/html?lang=en&srsltid=AfmBOopPb-IUA18V-eU0VP087zj3ctPAZB2yO6afaBDR-vX-Qyf-lI7O

  We found no studies or reports of OMT use for the management of PVPS. […] The differential diagnosis for chronic testicular pain after vasectomy is broad and includes epididymitis, infection, psychogenic pain, local neuropathy, nerve impingement, and referred pain; pelvic floor dysfunction (muscle dysfunction or myofascial trigger points) is infrequently considered. […] Pelvic floor dysfunction is a cause of chronic pelvic pain syndrome (CPPS), which has not been commonly associated with vasectomy, if at all. […] Although pelvic floor physical therapy was unsuccessful in our patient, OMT was better able to target his suspected pelvic floor dysfunction, as well as somatic dysfunction in his lumbar spine, pelvis, and abdominal musculature. […] Given the heterogeneity of PVPS and the unknown prevalence of pelvic floor dysfunction as the source of chronic pain after vasectomy, an evaluation by an osteopathic physician to assess and treat the pelvic floor and surrounding structures may be useful for symptoms refractory to more traditional treatments.

• #36 Osteopathic Manipulative Treatment as a Novel Way to Manage Postvasectomy Pain Syndrome

  https://www.degruyterbrill.com/document/doi/10.7556/jaoa.2018.162/html?lang=en&srsltid=AfmBOopPb-IUA18V-eU0VP087zj3ctPAZB2yO6afaBDR-vX-Qyf-lI7O

  We found no studies or reports of OMT use for the management of PVPS. […] The differential diagnosis for chronic testicular pain after vasectomy is broad and includes epididymitis, infection, psychogenic pain, local neuropathy, nerve impingement, and referred pain; pelvic floor dysfunction (muscle dysfunction or myofascial trigger points) is infrequently considered. […] Pelvic floor dysfunction is a cause of chronic pelvic pain syndrome (CPPS), which has not been commonly associated with vasectomy, if at all. […] Although pelvic floor physical therapy was unsuccessful in our patient, OMT was better able to target his suspected pelvic floor dysfunction, as well as somatic dysfunction in his lumbar spine, pelvis, and abdominal musculature. […] Given the heterogeneity of PVPS and the unknown prevalence of pelvic floor dysfunction as the source of chronic pain after vasectomy, an evaluation by an osteopathic physician to assess and treat the pelvic floor and surrounding structures may be useful for symptoms refractory to more traditional treatments.

• #37 Osteopathic Manipulative Treatment as a Novel Way to Manage Postvasectomy Pain Syndrome

  https://www.degruyterbrill.com/document/doi/10.7556/jaoa.2018.162/html?lang=en&srsltid=AfmBOopPb-IUA18V-eU0VP087zj3ctPAZB2yO6afaBDR-vX-Qyf-lI7O

  We found no studies or reports of OMT use for the management of PVPS. […] The differential diagnosis for chronic testicular pain after vasectomy is broad and includes epididymitis, infection, psychogenic pain, local neuropathy, nerve impingement, and referred pain; pelvic floor dysfunction (muscle dysfunction or myofascial trigger points) is infrequently considered. […] Pelvic floor dysfunction is a cause of chronic pelvic pain syndrome (CPPS), which has not been commonly associated with vasectomy, if at all. […] Although pelvic floor physical therapy was unsuccessful in our patient, OMT was better able to target his suspected pelvic floor dysfunction, as well as somatic dysfunction in his lumbar spine, pelvis, and abdominal musculature. […] Given the heterogeneity of PVPS and the unknown prevalence of pelvic floor dysfunction as the source of chronic pain after vasectomy, an evaluation by an osteopathic physician to assess and treat the pelvic floor and surrounding structures may be useful for symptoms refractory to more traditional treatments.

• #38 Osteopathic Manipulative Treatment as a Novel Way to Manage Postvasectomy Pain Syndrome

  https://www.degruyterbrill.com/document/doi/10.7556/jaoa.2018.162/html?lang=en&srsltid=AfmBOopPb-IUA18V-eU0VP087zj3ctPAZB2yO6afaBDR-vX-Qyf-lI7O

  We found no studies or reports of OMT use for the management of PVPS. […] The differential diagnosis for chronic testicular pain after vasectomy is broad and includes epididymitis, infection, psychogenic pain, local neuropathy, nerve impingement, and referred pain; pelvic floor dysfunction (muscle dysfunction or myofascial trigger points) is infrequently considered. […] Pelvic floor dysfunction is a cause of chronic pelvic pain syndrome (CPPS), which has not been commonly associated with vasectomy, if at all. […] Although pelvic floor physical therapy was unsuccessful in our patient, OMT was better able to target his suspected pelvic floor dysfunction, as well as somatic dysfunction in his lumbar spine, pelvis, and abdominal musculature. […] Given the heterogeneity of PVPS and the unknown prevalence of pelvic floor dysfunction as the source of chronic pain after vasectomy, an evaluation by an osteopathic physician to assess and treat the pelvic floor and surrounding structures may be useful for symptoms refractory to more traditional treatments.

• #39

  https://journals.lww.com/ajandrology/fulltext/2016/18030/an_overview_of_the_management_of_post_vasectomy.2.aspx

  Post-vasectomy pain syndrome remains one of the more challenging urological problems to manage. This can be a frustrating process for both the patient and clinician as there is no well-recognized diagnostic regimen or reliable effective treatment. […] Post-vasectomy pain syndrome is defined as at least 3 months of chronic or intermittent scrotal content pain. […] PVPS is defined as constant or intermittent testicular pain for 3 months or longer with a severity that interferes with daily activities prompting the patient to seek medical treatment. […] The evaluation includes a thorough history and physical examination. […] PVPS is a diagnosis of exclusion and the diagnosis should only be made after all these investigative studies have been performed. […] Currently, there are no published data with good evidence regarding non-surgical intervention for PVPS.

• #40 Vasectomy Procedures – Medical Clinical Policy Bulletins | Aetna

  https://www.aetna.com/cpb/medical/data/1_99/0027.html

  Aetna considers vasectomy reversal medically necessary for the treatment of post-vasectomy pain syndrome if member has failed non-steroidal anti-inflammatory medications and local nerve blocks/steroid injections. […] Tan and Levine (2016) stated that post-vasectomy pain syndrome (PVPS) remains one of the more challenging urological problems to manage. This can be a frustrating process for both the patient and clinician as there is no well-recognized diagnostic regimen or reliable effective treatment. […] The authors concluded that MDSC was a reasonably successful, durable and valuable approach for PVPS, especially when pain involves multiple structures in the scrotum (testis, epididymis, spermatic cord). […] The authors concluded that in their experience, VR had a high rate of success for relief of the PVPS.

• #41 Understanding Post-Vasectomy Pain Syndrome and its Management – Top Vasectomy Reversal Doctor NYC

  https://vasectomyreversal-nyc.com/understanding-post-vasectomy-pain-syndrome-and-its-management/

  Post-Vasectomy Pain Syndrome (PVPS) is characterized by chronic or intermittent testicular pain that occurs after a vasectomy. […] Diagnosing PVPS can be complex, as there are no specific tests for the condition. Instead, doctors rely on comprehensive assessments, including: Medical History: A thorough discussion of symptoms and medical history. Physical Examination: A detailed physical examination to evaluate the affected area. Exclusion of Other Causes: The elimination of other potential sources of testicular pain, such as infection or injury. […] Post-Vasectomy Pain Syndrome is a complex condition, but it can be managed with the right approach. If you are experiencing symptoms of PVPS or have questions about this condition, don’t hesitate to reach out for support and guidance. […] Understanding Post-Vasectomy Pain Syndrome (PVPS): Implications for Vasectomy Reversal.

• #42

  https://journals.lww.com/ajandrology/fulltext/2016/18030/an_overview_of_the_management_of_post_vasectomy.2.aspx

  Post-vasectomy pain syndrome remains one of the more challenging urological problems to manage. This can be a frustrating process for both the patient and clinician as there is no well-recognized diagnostic regimen or reliable effective treatment. […] Post-vasectomy pain syndrome is defined as at least 3 months of chronic or intermittent scrotal content pain. […] PVPS is defined as constant or intermittent testicular pain for 3 months or longer with a severity that interferes with daily activities prompting the patient to seek medical treatment. […] The evaluation includes a thorough history and physical examination. […] PVPS is a diagnosis of exclusion and the diagnosis should only be made after all these investigative studies have been performed. […] Currently, there are no published data with good evidence regarding non-surgical intervention for PVPS.

• #43 Post-vasectomy pain syndrome: diagnosis, management and treatment options – Sinha – Translational Andrology and Urology

  https://tau.amegroups.org/article/view/15005/html

  One study specifically evaluated the use of MDSC in patients with PVPS. […] Several studies have proven the effectiveness of MDSC in patients with various etiologies for chronic orchalgia. […] Epididymectomy is most effective when pain is localized to the epididymis and not diffused around the entire cord or testicle. […] Vasectomy reversal, or vasovasostomy, has been shown to significantly improve pain in patients with PVPS. […] Orchiectomy serves as a last resort for relief of PVPS if all other surgical options have failed in resolving symptoms. […] As a diagnosis of exclusion, patients often go through a rigorous work up and are eager to start treatment once their diagnosis is established. […] PVPS treatments range from noninvasive therapies and pharmacologic treatments, to surgical interventions.

• #44 Post-vasectomy pain syndrome – Give Legacy

  https://www.givelegacy.com/resources/post-vasectomy-pain-syndrome/

  Post-vasectomy pain syndrome affects roughly 12% of vasectomy patients. […] Potential causes of pain after vasectomy include damage to testicular structures, nerve compression, inflammation, or scar tissue. Pain may also be caused by non-vasectomy-related problems, such as varicocele and bacterial infections so a thorough medical examination is important. […] Symptoms of post-vasectomy pain syndrome include a dull ache in one or both testicles, pain with intercourse, and pain with physical exertion. […] The causes of post vasectomy pain syndrome are not entirely understood. […] Pain has also been attributed to direct damage to spermatic cord structures, compression of nerves in the spermatic cord via inflammation, and scar tissue, as a result of the vasectomy surgery. […] A 2013 review suggests that this psychological impact may contribute to cases of post-vasectomy pain syndrome, stating that psychogenic causes for the pain must be entertained when no physiological complications can be found.

• #45 Post Vasectomy Pain – need help | Vasectomy | Forums

  https://patient.info/forums/discuss/post-vasectomy-pain-need-help-259816

  Dr’s will prescribe antibiotics as it is a cheap drug, not only that most GP’s are ignorant of PVPS – some even deny there is actually a syndrome still. […] I eventually got a letter from the consultant stating a reversal gave a 70% of reducing the pain – with this letter in front of them the surgery then referred me back to the consultant. […] Given the reversal has a 70% success rate of reducing pain that leaves 30%….within that 30% is a percentage where I’ll be exactly the same after surgery…in other words it will be reversed but pain levels could remain as they are now but there is also a percentage risk that the reversal can increase the level of pain. […] Yep life has been stolen by the NHS who told me there was no evidence of long term risk to mens physical or mental health…they sort of neglected to mention the 40yrs+ worth of evidence research which confirms there is very real risks to both mental and physical health. […] Not once in any NHS literature or site have I seen an honest breakdown of the risks from a vasectomy. If a man was told clearly there is somewhere between a 5% and 30% chance of losing their sex life, putting huge strain on relationships and employment they would never go for a vasectomy.

• #46 Post vasectomy pain after 2 months | Vasectomy | Forums

  https://patient.info/forums/discuss/post-vasectomy-pain-after-2-months-544210

  The official NHS rate is that 1 in 10 of men will suffer some form of long term pain after vasectomy – other reports and urologists put that risk at between 15% to above 43% […] Ibuprofen will not even touch the surface of pain sadly and you really need to get back to GP for prescription strength meds. […] Be warned many GP’s are either unaware of PVP or in total denial over it. Therefore you might find your GP will insist it is an infection (which in fairness it may well be) and not give you pain relief but insist on high dose high strength antibiotics. […] Reversal can help BUT the added complication there is that a reversal can also trigger PVP and if you already have it then it can increase pain etc. That said many who go for reversal find a reduction in pain, sadly it cannot ever be totally eradicated but at least it can possibly come down to a level you can live with.

• #47 Post Vasectomy Pain – need help | Vasectomy | Forums

  https://patient.info/forums/discuss/post-vasectomy-pain-need-help-259816

  Dr’s will prescribe antibiotics as it is a cheap drug, not only that most GP’s are ignorant of PVPS – some even deny there is actually a syndrome still. […] I eventually got a letter from the consultant stating a reversal gave a 70% of reducing the pain – with this letter in front of them the surgery then referred me back to the consultant. […] Given the reversal has a 70% success rate of reducing pain that leaves 30%….within that 30% is a percentage where I’ll be exactly the same after surgery…in other words it will be reversed but pain levels could remain as they are now but there is also a percentage risk that the reversal can increase the level of pain. […] Yep life has been stolen by the NHS who told me there was no evidence of long term risk to mens physical or mental health…they sort of neglected to mention the 40yrs+ worth of evidence research which confirms there is very real risks to both mental and physical health. […] Not once in any NHS literature or site have I seen an honest breakdown of the risks from a vasectomy. If a man was told clearly there is somewhere between a 5% and 30% chance of losing their sex life, putting huge strain on relationships and employment they would never go for a vasectomy.

• #48 Post Vasectomy Pain Syndrome — How Long Does PVPS Last?

  https://clarewellclinics.co.uk/family-planning/vasectomy/post-vasectomy-pain-syndrome/

  While there is no guaranteed way to prevent PVPS, there are several steps you can take to minimise your risk: Choose an experienced clinician: This can reduce the risk of surgical complications. Discuss your concerns: Ask questions about the potential risks and complications, and make sure you understand the procedure and the outcomes. Follow aftercare instructions: This includes taking any prescribed medication (if appropriate) and avoiding strenuous activities for a few days. Rest and recover: Take time to rest, avoid heavy lifting and exercise. Seek medical attention if you experience any unusual pain and discomfort. Early intervention can help prevent PVPS from becoming a chronic condition. […] In most cases, PVPS usually goes away on its own within a few weeks or months after the procedure. However, for some patients, the pain may persist for a longer period, and in rare cases, it can become chronic. Chronic PVPS is defined as pain that persists for more than three months after the vasectomy procedure. It can be a challenging condition to treat, and the treatment options depend on the severity of the symptoms.

• #49 :: WJMH :: World Journal of Men’s Health

  https://wjmh.org/DOIx.php?id=10.5534/wjmh.200073

  The incidence rate of long-term pain requiring surgical treatment has been estimated to be approximately 0.1%. […] Many studies reported that patients with PVPS were pain-free postoperatively and were satisfied with the outcome of epididymectomy or VR. […] However, there was no significant difference between epididymectomy and VR groups in the degree of pain relief and patients’ satisfaction with the outcome of surgery. […] A multidisciplinary team could be used in severe cases such as psychiatric assessments for emotional disorders and assessments of the severity of pain by anesthesiologists.

• #50 Osteopathic Manipulative Treatment as a Novel Way to Manage Postvasectomy Pain Syndrome

  https://www.degruyterbrill.com/document/doi/10.7556/jaoa.2018.162/html?lang=en&srsltid=AfmBOopPb-IUA18V-eU0VP087zj3ctPAZB2yO6afaBDR-vX-Qyf-lI7O

  We found no studies or reports of OMT use for the management of PVPS. […] The differential diagnosis for chronic testicular pain after vasectomy is broad and includes epididymitis, infection, psychogenic pain, local neuropathy, nerve impingement, and referred pain; pelvic floor dysfunction (muscle dysfunction or myofascial trigger points) is infrequently considered. […] Pelvic floor dysfunction is a cause of chronic pelvic pain syndrome (CPPS), which has not been commonly associated with vasectomy, if at all. […] Although pelvic floor physical therapy was unsuccessful in our patient, OMT was better able to target his suspected pelvic floor dysfunction, as well as somatic dysfunction in his lumbar spine, pelvis, and abdominal musculature. […] Given the heterogeneity of PVPS and the unknown prevalence of pelvic floor dysfunction as the source of chronic pain after vasectomy, an evaluation by an osteopathic physician to assess and treat the pelvic floor and surrounding structures may be useful for symptoms refractory to more traditional treatments.

• #51 Osteopathic Manipulative Treatment as a Novel Way to Manage Postvasectomy Pain Syndrome

  https://www.degruyter.com/document/doi/10.7556/jaoa.2018.162/html?lang=en

  We found no studies or reports of OMT use for the management of PVPS. […] Pelvic floor dysfunction may develop in some patients with symptoms refractory to more traditional treatment, placing them on the spectrum of CPPS. […] We hypothesized that pelvic floor dysfunction may occur via a pain-spasm-dysfunction cycle, wherein the initial surgical insult and discomfort result in pelvic floor contractions or guarding, which in turn lead to painful spasms, which compress nerves, compromise local blood flow, and, ultimately, cause pelvic floor dysfunction. […] To our knowledge, this is the first reported use of OMT for PVPS. […] Further research should investigate the prevalence of pelvic floor dysfunction in men with PVPS, the best candidates for OMT in this population, and the specific techniques and long-term outcomes of OMT for PVPS.

• #52 Post-vasectomy pain syndrome: diagnosis, management and treatment options – Sinha – Translational Andrology and Urology

  https://tau.amegroups.org/article/view/15005/15152

  Post-vasectomy pain syndrome (PVPS) is diagnosis of exclusion, and may be caused by direct damage to spermatic cord structures, compression of nerves in the spermatic cord via inflammation, back pressure from epididymal congestion, and perineural fibrosis. […] Post-vasectomy pain syndrome (PVPS) is widely known as either constant or intermittent testicular pain for greater than three months. […] The most common symptom of PVPS is persistent orchalgia greater than three months after surgery, however, some patients present with pain with ejaculation, intercourse or erection. […] Ultimately, the diagnosis of PVPS is most safely made as a diagnosis of exclusion. […] A thorough history and physical is required at least three months after surgery. […] With a detailed history and physical exam serially for several months following vasectomy, a diagnosis of PVPS can be safely made. […] Thus, a comprehensive evaluation is warranted to best establish a diagnosis in patients with chronic testicular pain.

• #53 Incidence of Post-Vasectomy Pain: Systematic Review and Meta-Analysis

  https://www.mdpi.com/1660-4601/17/5/1788

  This is the first systematic review and meta-analysis to ascertain incidences of post-vasectomy pain following traditional scalpel, or non-scalpel vasectomy. […] Post-vasectomy pain syndrome (PVPS), also known as chronic post-vasectomy pain, is formally defined as an intermittent or constant unilateral or bilateral testicular pain three months or longer in duration which significantly interferes with daily activities of the patient so as to prompt him to seek medical attention. […] Chronic pain following vasectomy is very challenging to diagnose and treat. Being a diagnosis of exclusion, it exposes the patient to a series of investigations and treatment regimens over months. […] Although chronic post-vasectomy pain is a recognized complication, current literature shows lack of consensus regarding its frequency. Recent narrative reviews report the incidence of post-vasectomy pain to be between 1% and 6%.

• #54 Post-vasectomy pain syndrome: diagnosis, management and treatment options – Sinha – Translational Andrology and Urology

  https://tau.amegroups.org/article/view/15005/html

  Post-vasectomy pain syndrome (PVPS) is diagnosis of exclusion, and may be caused by direct damage to spermatic cord structures, compression of nerves in the spermatic cord via inflammation, back pressure from epididymal congestion, and perineural fibrosis. […] Post-vasectomy pain syndrome (PVPS) is widely known as either constant or intermittent testicular pain for greater than three months. […] The most common symptom of PVPS is persistent orchalgia greater than three months after surgery, however, some patients present with pain with ejaculation, intercourse or erection. […] Ultimately, the diagnosis of PVPS is most safely made as a diagnosis of exclusion. […] A thorough history and physical is required at least three months after surgery. […] With a detailed history and physical exam serially for several months following vasectomy, a diagnosis of PVPS can be safely made.

• #55 Post-vasectomy pain syndrome: diagnosis, management and treatment options

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5503923/

  It is crucial to differentiate acute post-operative pain from PVPS. The most common symptom of PVPS is persistent orchalgia greater than three months after surgery, however, some patients present with pain with ejaculation, intercourse or erection. […] Ultimately, the diagnosis of PVPS is most safely made as a diagnosis of exclusion. A thorough history and physical is required at least three months after surgery. All patients with chronic testicular pain should undergo scrotal ultrasound with Doppler color-flow. […] Management of PVPS can be frustrating for both the clinician and the patient. Treatment should begin with the most noninvasive options and progress towards surgical management if symptoms persist. […] Surgical options include excision of sperm granuloma, microdenervation of spermatic cord, epididymectomy, vasovasostomy and in severe cases, orchiectomy.

• #56

  https://journals.lww.com/ajandrology/fulltext/2016/18030/an_overview_of_the_management_of_post_vasectomy.2.aspx

  Post-vasectomy pain syndrome remains one of the more challenging urological problems to manage. This can be a frustrating process for both the patient and clinician as there is no well-recognized diagnostic regimen or reliable effective treatment. […] Post-vasectomy pain syndrome is defined as at least 3 months of chronic or intermittent scrotal content pain. […] PVPS is defined as constant or intermittent testicular pain for 3 months or longer with a severity that interferes with daily activities prompting the patient to seek medical treatment. […] The evaluation includes a thorough history and physical examination. […] PVPS is a diagnosis of exclusion and the diagnosis should only be made after all these investigative studies have been performed. […] Currently, there are no published data with good evidence regarding non-surgical intervention for PVPS.

• #57 Post-vasectomy pain syndrome: diagnosis, management and treatment options – Sinha – Translational Andrology and Urology

  https://tau.amegroups.org/article/view/15005/html

  A spermatic cord block may be performed to isolate the scrotum as the origin for pain. […] Thus, a comprehensive evaluation is warranted to best establish a diagnosis in patients with chronic testicular pain. […] Management of PVPS can be frustrating for both the clinician and the patient. […] Treatment should begin with the most noninvasive options and progress towards surgical management if symptoms persist. […] Surgical options include excision of sperm granuloma, microdenervation of spermatic cord, epididymectomy, vasovasostomy and in severe cases, orchiectomy. […] Microdenervation of the spermatic cord (MDSC) is the precise transection of all nerves within the spermatic cord. […] Patients who had effective temporary relief with spermatic cord block predicted a successful MDSC.

• #58 Why Men Experience Lower Abdominal Pain After Vasectomy? – Pelvis.nyc

  https://pelvis.nyc/why-men-experience-lower-abdominal-pain-after-vasectomy/

  Post-vasectomy pain syndrome (PVPS) is a continuous or intermittent testicular pain lasting more than three months. About 12% of men who undergo a vasectomy experience this discomfort, which leads to some form of medical treatment. […] The diagnosis of PVPS must be an exclusion diagnosis. A three-month follow-up history and physical are recommended after surgery. A scrotal ultrasound using color-flow Doppler is administered to every patient suffering from chronic testicular pain. It is recommended to obtain a routine urinalysis, a urine culture, and a semen culture to determine whether there is an infection.

• #59

  https://journals.lww.com/ajandrology/fulltext/2016/18030/an_overview_of_the_management_of_post_vasectomy.2.aspx

  Post-vasectomy pain syndrome remains one of the more challenging urological problems to manage. This can be a frustrating process for both the patient and clinician as there is no well-recognized diagnostic regimen or reliable effective treatment. […] Post-vasectomy pain syndrome is defined as at least 3 months of chronic or intermittent scrotal content pain. […] PVPS is defined as constant or intermittent testicular pain for 3 months or longer with a severity that interferes with daily activities prompting the patient to seek medical treatment. […] The evaluation includes a thorough history and physical examination. […] PVPS is a diagnosis of exclusion and the diagnosis should only be made after all these investigative studies have been performed. […] Currently, there are no published data with good evidence regarding non-surgical intervention for PVPS.

• #60 Chronic Post Vasectomy Pain Syndrome: What The Hell?

  https://hischoiceraleigh.com/chronic-post-vasectomy-pain-syndrome-a-real-but-rare-risk-of-vasectomy/

  Chronic Post Vasectomy Pain Syndrome is a diagnosis of exclusion. This means all other causes must be ruled out before a diagnosis can be made. […] If you are diagnosed with chronic Post Vasectomy Pain Syndrome then you may have to live with that diagnosis for the remainder of your life. […] Chronic scrotal pain is typically a diagnosis of exclusion, meaning other potential causes must first be thoroughly evaluated and ruled out. If the pain is persistent, occurring daily for three months or longer following a vasectomy, and no other underlying causes can be identified, a diagnosis of chronic scrotal pain is made. […] Before treating chronic scrotal pain, it is essential to establish an accurate diagnosis.

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