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. […] 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. […] 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.

• #2 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. 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. […] 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. Nonsurgical treatments include both pharmacotherapy and nonsurgical modalities to alleviate pain. Medical treatment usually begins with scheduled non-steroidal anti-inflammatory drugs (NSAIDs) for 4-6 weeks. If NSAIDs do not improve testicular pain, the second line medication recommended is a tricyclic antidepressant (TCA) or gabapentin.

• #3 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. 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. […] 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. Nonsurgical treatments include both pharmacotherapy and nonsurgical modalities to alleviate pain. Medical treatment usually begins with scheduled non-steroidal anti-inflammatory drugs (NSAIDs) for 4-6 weeks. If NSAIDs do not improve testicular pain, the second line medication recommended is a tricyclic antidepressant (TCA) or gabapentin.

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

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

  Treatment for PVPS depends on your symptoms and how much pain you have. […] Pain medications. Anti-inflammatory medications such as ibuprofen (Advil, Motrin IB, others) may help with pain or swelling. Men who have pain before or after ejaculation can take these medications prior to intercourse. Prescription pain medications also may be used to treat pain. […] If anti-inflammatory medications do not help after four weeks, 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. […] Supportive underwear. Wearing a jock strap or compression shorts may help reduce pain in the testicles. […] Ice or heat. An ice pack or a warming pad may help reduce pain. Sitting in a warm bath also may be helpful during a flare-up.

• #5 Post-vasectomy pain syndrome

  https://johnsonmemorial.org/jmh-health/disease-conditions/con-20517005

  Treatment for PVPS depends on your symptoms and how much pain you have. […] Pain medications. Anti-inflammatory medications such as ibuprofen (Advil, Motrin IB, others) may help with pain or swelling. Men who have pain before or after ejaculation can take these medications prior to intercourse. Prescription pain medications also may be used to treat pain. […] Other medications. If anti-inflammatory medications do not help after four weeks, 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. […] Supportive underwear. Wearing a jock strap or compression shorts may help reduce pain in the testicles. […] Ice or heat. An ice pack or a warming pad may help reduce pain. Sitting in a warm bath also may be helpful during a flare-up.

• #6 Post Vasectomy Pain Syndrome – Dayton Physicians Network

  https://daytonphysicians.com/post-vasectomy-pain-syndrome/

  Post vasectomy pain syndrome is thought to result from a build-up of fluid in the epididymis following a vasectomy leading to a chronic dull ache in the testes. […] Up to one-in-five men have ongoing pain or discomfort after a vasectomy which eventually resolves with time. (Urology Care Foundation, 2019). […] Adequate scrotal support with jock strap […] Avoid strenuous activity […] Sit in a warm bath as needed for discomfort. […] Anti-inflammatory such as ibuprofen 600 mg 3 times daily or naproxen 220 mg twice daily taken with food or a proton pump inhibitor to help prevent GI upset or the possibility of GI ulcer/bleed. Treatment course 7 to 14-days depending on the severity of symptoms. […] If these measures are not enough to relieve pain, local nerve blocks or steroid injections may be provided by a pain specialist. […] In cases where pain does not respond to therapy, surgery may be required, including a vasectomy reversal.

• #7 Post-vasectomy pain syndrome

  https://johnsonmemorial.org/jmh-health/disease-conditions/con-20517005

  Treatment for PVPS depends on your symptoms and how much pain you have. […] Pain medications. Anti-inflammatory medications such as ibuprofen (Advil, Motrin IB, others) may help with pain or swelling. Men who have pain before or after ejaculation can take these medications prior to intercourse. Prescription pain medications also may be used to treat pain. […] Other medications. If anti-inflammatory medications do not help after four weeks, 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. […] Supportive underwear. Wearing a jock strap or compression shorts may help reduce pain in the testicles. […] Ice or heat. An ice pack or a warming pad may help reduce pain. Sitting in a warm bath also may be helpful during a flare-up.

• #8

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

  Initial pharmacological therapy should include non-steroidal anti-inflammatory drugs (NSAIDs) over a period of 24 weeks. […] Failing NSAIDs therapy, we recommend using a tricyclic antidepressant (TCA). […] TCA may take 2-3 weeks from initiation of therapy to be effective. […] A series of spermatic cord blocks with local anesthetic agents with or without steroids to disrupt the afferent pain pathway may also relieve testicular pain. […] Other nonsurgical techniques include pulsed radiofrequency of the spermatic cord and genital branch of the genitofemoral nerve for PVPS if the patient receives temporary relief from a spermatic cord block. […] Patients who fail medical therapy should be considered for surgical intervention. Surgical intervention includes excision of sperm granuloma, microdenervation of the spermatic cord (MDSC), epididymectomy, vasectomy reversal or orchiectomy. […] MDSC is a relatively new surgical option which became more popular over the last two decades. […] There has only been one study to date that has specifically evaluated the success rate of MDSC for PVPS.

• #9 Post-vasectomy pain syndrome: Symptoms and outlook

  https://www.medicalnewstoday.com/articles/post-vasectomy-pain-syndrome

  Post-vasectomy pain syndrome (PVPS) is testicular pain that can occur after having a vasectomy. The pain lasts for 3 months or longer and affects daily activities. […] Treatment for PVPS may include medication or complementary treatments to help relieve pain, such as: nonsteroidal anti-inflammatory drugs (NSAIDs), tricyclic antidepressants (TCAs), gabapentin, a type of nerve pain medication, local or regional nerve blocks, acupuncture. […] The first-line treatment for PVPS is usually NSAIDs for 4 to 6 weeks. If these are ineffective at relieving pain, second-line drug therapies may include TCAs or gabapentin. […] If medications are not effective, people may require surgical treatment. This may include: vasectomy reversal, which reconnects the vas deferens, epididymectomy, which refers to surgery to remove the epididymis, microsurgical denervation of the spermatic cord (MDSC), or cord stripping, which removes the nerves of the spermatic cord to relieve pain, orchiectomy, which is surgery to remove the testicles, which may be a last resort treatment.

• #10 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. 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. […] 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. Nonsurgical treatments include both pharmacotherapy and nonsurgical modalities to alleviate pain. Medical treatment usually begins with scheduled non-steroidal anti-inflammatory drugs (NSAIDs) for 4-6 weeks. If NSAIDs do not improve testicular pain, the second line medication recommended is a tricyclic antidepressant (TCA) or gabapentin.

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

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

  Treatment for PVPS depends on your symptoms and how much pain you have. […] Pain medications. Anti-inflammatory medications such as ibuprofen (Advil, Motrin IB, others) may help with pain or swelling. Men who have pain before or after ejaculation can take these medications prior to intercourse. Prescription pain medications also may be used to treat pain. […] If anti-inflammatory medications do not help after four weeks, 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. […] Supportive underwear. Wearing a jock strap or compression shorts may help reduce pain in the testicles. […] Ice or heat. An ice pack or a warming pad may help reduce pain. Sitting in a warm bath also may be helpful during a flare-up.

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

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

  Either exclusively or in combination with pharmacotherapy, pelvic floor therapy and/or acupuncture may be offered to patients with PVPS. […] Failed pharmacotherapy and noninvasive modalities should trigger surgical intervention. 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. […] 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.

• #13 Post-vasectomy pain syndrome

  https://johnsonmemorial.org/jmh-health/disease-conditions/con-20517005

  Treatment for PVPS depends on your symptoms and how much pain you have. […] Pain medications. Anti-inflammatory medications such as ibuprofen (Advil, Motrin IB, others) may help with pain or swelling. Men who have pain before or after ejaculation can take these medications prior to intercourse. Prescription pain medications also may be used to treat pain. […] Other medications. If anti-inflammatory medications do not help after four weeks, 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. […] Supportive underwear. Wearing a jock strap or compression shorts may help reduce pain in the testicles. […] Ice or heat. An ice pack or a warming pad may help reduce pain. Sitting in a warm bath also may be helpful during a flare-up.

• #14 Post-vasectomy pain syndrome

  https://johnsonmemorial.org/jmh-health/disease-conditions/con-20517005

  Treatment for PVPS depends on your symptoms and how much pain you have. […] Pain medications. Anti-inflammatory medications such as ibuprofen (Advil, Motrin IB, others) may help with pain or swelling. Men who have pain before or after ejaculation can take these medications prior to intercourse. Prescription pain medications also may be used to treat pain. […] Other medications. If anti-inflammatory medications do not help after four weeks, 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. […] Supportive underwear. Wearing a jock strap or compression shorts may help reduce pain in the testicles. […] Ice or heat. An ice pack or a warming pad may help reduce pain. Sitting in a warm bath also may be helpful during a flare-up.

• #15 Post-vasectomy pain syndrome

  https://johnsonmemorial.org/jmh-health/disease-conditions/con-20517005

  Physical therapy. Men who have pain in the pelvic area or when they urinate may benefit from pelvic floor physical therapy to learn how to relax certain muscles in the pelvis. […] Nerve block. 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. […] Removal of sperm granuloma. Some men develop a small ball of scar tissue on the vas deferens without pain in any other part of the scrotum. Those men may experience pain relief after a procedure to remove the scar tissue. […] Microdenervation of the spermatic cord (MDSC). 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. Complications may include ongoing or worsening pain, development of fluid buildup in the sheath around a testicle that causes swelling in the scrotum (hydrocele), and testicular atrophy.

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

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

  Physical therapy. Men who have pain in the pelvic area or when they urinate may benefit from pelvic floor physical therapy to learn how to relax certain muscles in the pelvis. […] 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. […] Removal of sperm granuloma. Some men develop a small ball of scar tissue on the vas deferens without pain in any other part of the scrotum. Those men may experience pain relief after a procedure to remove the scar tissue. […] Microdenervation of the spermatic cord (MDSC). 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. Complications may include ongoing or worsening pain, development of fluid buildup in the sheath around a testicle that causes swelling in the scrotum (hydrocele), and testicular atrophy.

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

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

  Either exclusively or in combination with pharmacotherapy, pelvic floor therapy and/or acupuncture may be offered to patients with PVPS. […] Failed pharmacotherapy and noninvasive modalities should trigger surgical intervention. 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. […] 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.

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

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

  Nonsurgical treatments include both pharmacotherapy and nonsurgical modalities to alleviate pain. Medical treatment usually begins with scheduled non-steroidal anti-inflammatory drugs (NSAIDs) for 4-6 weeks. If NSAIDs do not improve testicular pain, the second line medication recommended is a tricyclic antidepressant (TCA) or gabapentin. […] Either exclusively or in combination with pharmacotherapy, pelvic floor therapy and/or acupuncture may be offered to patients with PVPS. […] Failed pharmacotherapy and noninvasive modalities should trigger surgical intervention. 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.

• #19 Post-vasectomy pain syndrome – Hancock Health

  https://www.hancockhealth.org/mayo-health-library/post-vasectomy-pain-syndrome/

  Epididymectomy. For men with pain of the epididymis, removing the C-shaped structure that stores sperm behind the testicle may relieve the pain. The procedure seems to be most effective in relieving pain in men who have a cyst, a granuloma or a mass on the epididymis. […] Vasectomy reversal (vasovasostomy). Reversing the vasectomy will restore sperm to the ejaculate and may restore fertility. This procedure may relieve pain and pressure that occur with ejaculation. For some men, vasectomy reversal is more effective than the MDSC approach in relieving pain. […] Orchiectomy. Removal of the testicle is a last resort for men who do not respond to more-conservative treatments. Even after the testicle is removed, men sometimes feel a phantom limb pain in the area where the testicle used to be. […] Your provider may consider acupuncture either alone or together with medication. Although there are no clinical trials that prove the effectiveness of acupuncture in treating PVPS, acupuncture is considered safe and noninvasive for men recently diagnosed with PVPS.

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

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

  Either exclusively or in combination with pharmacotherapy, pelvic floor therapy and/or acupuncture may be offered to patients with PVPS. […] Failed pharmacotherapy and noninvasive modalities should trigger surgical intervention. 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. […] 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.

• #21 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=AfmBOooqjkwqEYSB-VQztkl5TyLLI2NoI88aQ0t7rnekNw78caiEiMUc

  Postvasectomy pain syndrome (PVPS) can be debilitating and is notoriously difficult to treat, often requiring a multidisciplinary approach. […] After the patient’s urologist suggested orchiectomy, his family medicine physician referred him for OMT. The OMT interventions, applied over a 4-month period, were directed at the lumbar spine, pelvis, pelvic floor, and lower abdomen. After treatment, the patient reported absence of testicular pain most of the time and described his quality of life as 10 times better. […] We hypothesize a myofascial or musculoskeletal contribution to some cases of chronic pain after vasectomy, making OMT a reasonable treatment component in a multidisciplinary approach to patients with PVPS. […] The OMT interventions included treatment of the lumbar spine, pelvis, pelvic floor, and lower abdomen during a period of 4 months (10 visits).

• #22 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

  Postvasectomy pain syndrome (PVPS) can be debilitating and is notoriously difficult to treat, often requiring a multidisciplinary approach. […] After the patient’s urologist suggested orchiectomy, his family medicine physician referred him for OMT. The OMT interventions, applied over a 4-month period, were directed at the lumbar spine, pelvis, pelvic floor, and lower abdomen. After treatment, the patient reported absence of testicular pain most of the time and described his quality of life as 10 times better. […] We hypothesize a myofascial or musculoskeletal contribution to some cases of chronic pain after vasectomy, making OMT a reasonable treatment component in a multidisciplinary approach to patients with PVPS. […] The OMT interventions included treatment of the lumbar spine, pelvis, pelvic floor, and lower abdomen during a period of 4 months (10 visits).

• #23 Post-vasectomy pain syndrome

  https://johnsonmemorial.org/jmh-health/disease-conditions/con-20517005

  Physical therapy. Men who have pain in the pelvic area or when they urinate may benefit from pelvic floor physical therapy to learn how to relax certain muscles in the pelvis. […] Nerve block. 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. […] Removal of sperm granuloma. Some men develop a small ball of scar tissue on the vas deferens without pain in any other part of the scrotum. Those men may experience pain relief after a procedure to remove the scar tissue. […] Microdenervation of the spermatic cord (MDSC). 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. Complications may include ongoing or worsening pain, development of fluid buildup in the sheath around a testicle that causes swelling in the scrotum (hydrocele), and testicular atrophy.

• #24 Post-vasectomy pain syndrome

  https://johnsonmemorial.org/jmh-health/disease-conditions/con-20517005

  Physical therapy. Men who have pain in the pelvic area or when they urinate may benefit from pelvic floor physical therapy to learn how to relax certain muscles in the pelvis. […] Nerve block. 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. […] Removal of sperm granuloma. Some men develop a small ball of scar tissue on the vas deferens without pain in any other part of the scrotum. Those men may experience pain relief after a procedure to remove the scar tissue. […] Microdenervation of the spermatic cord (MDSC). 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. Complications may include ongoing or worsening pain, development of fluid buildup in the sheath around a testicle that causes swelling in the scrotum (hydrocele), and testicular atrophy.

• #25

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

  Initial pharmacological therapy should include non-steroidal anti-inflammatory drugs (NSAIDs) over a period of 24 weeks. […] Failing NSAIDs therapy, we recommend using a tricyclic antidepressant (TCA). […] TCA may take 2-3 weeks from initiation of therapy to be effective. […] A series of spermatic cord blocks with local anesthetic agents with or without steroids to disrupt the afferent pain pathway may also relieve testicular pain. […] Other nonsurgical techniques include pulsed radiofrequency of the spermatic cord and genital branch of the genitofemoral nerve for PVPS if the patient receives temporary relief from a spermatic cord block. […] Patients who fail medical therapy should be considered for surgical intervention. Surgical intervention includes excision of sperm granuloma, microdenervation of the spermatic cord (MDSC), epididymectomy, vasectomy reversal or orchiectomy. […] MDSC is a relatively new surgical option which became more popular over the last two decades. […] There has only been one study to date that has specifically evaluated the success rate of MDSC for PVPS.

• #26

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

  Initial pharmacological therapy should include non-steroidal anti-inflammatory drugs (NSAIDs) over a period of 24 weeks. […] Failing NSAIDs therapy, we recommend using a tricyclic antidepressant (TCA). […] TCA may take 2-3 weeks from initiation of therapy to be effective. […] A series of spermatic cord blocks with local anesthetic agents with or without steroids to disrupt the afferent pain pathway may also relieve testicular pain. […] Other nonsurgical techniques include pulsed radiofrequency of the spermatic cord and genital branch of the genitofemoral nerve for PVPS if the patient receives temporary relief from a spermatic cord block. […] Patients who fail medical therapy should be considered for surgical intervention. Surgical intervention includes excision of sperm granuloma, microdenervation of the spermatic cord (MDSC), epididymectomy, vasectomy reversal or orchiectomy. […] MDSC is a relatively new surgical option which became more popular over the last two decades. […] There has only been one study to date that has specifically evaluated the success rate of MDSC for PVPS.

• #27 Post-Vasectomy Pain Syndrome (PVPS): Understanding Chronic Testicular Pain After Vasectomy – UroCare Chennai

  https://urocarechennai.com/blog/post-vasectomy-pain-syndrome-pvps-understanding-chronic-testicular-pain-after-vasectomy/

  PVPS is persistent or chronic pain in the testicles or scrotal region that occurs after a vasectomy and lasts for more than three months. […] There are several treatment options, ranging from conservative approaches to surgical intervention. […] Non-Surgical Treatments (First-Line Approach): Pain Management: Over-the-counter medications like ibuprofen or acetaminophen can help reduce discomfort. Anti-Inflammatory Medications: Corticosteroids or NSAIDs may help reduce inflammation. Pelvic Floor Therapy: Physical therapy targeting the pelvic muscles can sometimes relieve pain. Nerve Blocks: Injecting anesthetics into the affected nerves can temporarily relieve pain and help confirm a nerve-related cause. […] Minimally Invasive Procedures: Spermatic Cord Blocks: Injecting steroids and anesthetics into the spermatic cord can provide long-term pain relief. Microdenervation of the Spermatic Cord (MDSC): A surgical procedure that removes nerve fibers responsible for pain.

• #28

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

  Initial pharmacological therapy should include non-steroidal anti-inflammatory drugs (NSAIDs) over a period of 24 weeks. […] Failing NSAIDs therapy, we recommend using a tricyclic antidepressant (TCA). […] TCA may take 2-3 weeks from initiation of therapy to be effective. […] A series of spermatic cord blocks with local anesthetic agents with or without steroids to disrupt the afferent pain pathway may also relieve testicular pain. […] Other nonsurgical techniques include pulsed radiofrequency of the spermatic cord and genital branch of the genitofemoral nerve for PVPS if the patient receives temporary relief from a spermatic cord block. […] Patients who fail medical therapy should be considered for surgical intervention. Surgical intervention includes excision of sperm granuloma, microdenervation of the spermatic cord (MDSC), epididymectomy, vasectomy reversal or orchiectomy. […] MDSC is a relatively new surgical option which became more popular over the last two decades. […] There has only been one study to date that has specifically evaluated the success rate of MDSC for PVPS.

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

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

  Either exclusively or in combination with pharmacotherapy, pelvic floor therapy and/or acupuncture may be offered to patients with PVPS. […] Failed pharmacotherapy and noninvasive modalities should trigger surgical intervention. 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. […] 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.

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

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

  Nonsurgical treatments include both pharmacotherapy and nonsurgical modalities to alleviate pain. Medical treatment usually begins with scheduled non-steroidal anti-inflammatory drugs (NSAIDs) for 4-6 weeks. If NSAIDs do not improve testicular pain, the second line medication recommended is a tricyclic antidepressant (TCA) or gabapentin. […] Either exclusively or in combination with pharmacotherapy, pelvic floor therapy and/or acupuncture may be offered to patients with PVPS. […] Failed pharmacotherapy and noninvasive modalities should trigger surgical intervention. 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.

• #31 Post-vasectomy pain syndrome

  https://johnsonmemorial.org/jmh-health/disease-conditions/con-20517005

  Physical therapy. Men who have pain in the pelvic area or when they urinate may benefit from pelvic floor physical therapy to learn how to relax certain muscles in the pelvis. […] Nerve block. 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. […] Removal of sperm granuloma. Some men develop a small ball of scar tissue on the vas deferens without pain in any other part of the scrotum. Those men may experience pain relief after a procedure to remove the scar tissue. […] Microdenervation of the spermatic cord (MDSC). 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. Complications may include ongoing or worsening pain, development of fluid buildup in the sheath around a testicle that causes swelling in the scrotum (hydrocele), and testicular atrophy.

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

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

  Either exclusively or in combination with pharmacotherapy, pelvic floor therapy and/or acupuncture may be offered to patients with PVPS. […] Failed pharmacotherapy and noninvasive modalities should trigger surgical intervention. 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. […] 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.

• #33 Post-vasectomy pain syndrome

  https://johnsonmemorial.org/jmh-health/disease-conditions/con-20517005

  Physical therapy. Men who have pain in the pelvic area or when they urinate may benefit from pelvic floor physical therapy to learn how to relax certain muscles in the pelvis. […] Nerve block. 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. […] Removal of sperm granuloma. Some men develop a small ball of scar tissue on the vas deferens without pain in any other part of the scrotum. Those men may experience pain relief after a procedure to remove the scar tissue. […] Microdenervation of the spermatic cord (MDSC). 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. Complications may include ongoing or worsening pain, development of fluid buildup in the sheath around a testicle that causes swelling in the scrotum (hydrocele), and testicular atrophy.

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

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

  Either exclusively or in combination with pharmacotherapy, pelvic floor therapy and/or acupuncture may be offered to patients with PVPS. […] Failed pharmacotherapy and noninvasive modalities should trigger surgical intervention. 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. […] 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.

• #35 Post-vasectomy pain syndrome – Wikipedia

  https://en.wikipedia.org/wiki/Post-vasectomy_pain_syndrome

  Post-vasectomy pain syndrome (PVPS) is a chronic and sometimes debilitating genital pain condition that may develop immediately or several years after vasectomy. Because this condition is a syndrome, there is no single treatment method, therefore efforts focus on mitigating/relieving the individual patient’s specific pain. […] Treatment depends on the proximate cause. In one study, it was reported that 9 of 13 men who underwent vasectomy reversal in an attempt to relieve post-vasectomy pain syndrome became pain-free, though the followup was only one month in some cases. Another study found that 24 of 32 men had relief after vasectomy reversal. […] Nerve entrapment is treated with surgery to free the nerve from the scar tissue, or to cut the nerve. One study reported that denervation of the spermatic cord provided complete relief at the first follow-up visit in 13 of 17 cases, and that the other four patients reported improvement. As nerves may regrow, long-term studies are needed. […] One study found that epididymectomy provided relief for 50% of patients with post-vasectomy pain syndrome. […] Orchiectomy is recommended usually only after other surgeries have failed.

• #36 Post-vasectomy pain syndrome

  https://johnsonmemorial.org/jmh-health/disease-conditions/con-20517005

  Epididymectomy. For men with pain of the epididymis, removing the C-shaped structure that stores sperm behind the testicle may relieve the pain. The procedure seems to be most effective in relieving pain in men who have a cyst, a granuloma or a mass on the epididymis. […] Vasectomy reversal (vasovasostomy). Reversing the vasectomy will restore sperm to the ejaculate and may restore fertility. This procedure may relieve pain and pressure that occur with ejaculation. For some men, vasectomy reversal is more effective than the MDSC approach in relieving pain. […] Orchiectomy. Removal of the testicle is a last resort for men who do not respond to more-conservative treatments. Even after the testicle is removed, men sometimes feel a phantom limb pain in the area where the testicle used to be.

• #37

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

  Epididymectomy continues to remain a more popular approach compared to MDSC especially in Europe. […] The reported success rates with epididymectomy range from 50% to 92% and have been reported to produce a better result in relieving pain if a structural abnormality (cyst, granuloma or mass) was noted in the epididymis on examination or with ultrasonography. […] Vaso-vasostomy appears to be an intuitive solution to PVPS. […] However, these studies show that up to 100% of patients experience some improvement in pain scores, and complete resolution of pain have been reported to be as high as 50%-69%. […] Orchiectomy is considered the last resort in patients who do not respond to other means of therapy. […] On the basis of these results, the authors recommended inguinal orchiectomy as the procedure of choice for the management of chronic testicular pain when other management is unsuccessful.

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

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

  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.

• #39 Post-vasectomy pain syndrome

  https://johnsonmemorial.org/jmh-health/disease-conditions/con-20517005

  Epididymectomy. For men with pain of the epididymis, removing the C-shaped structure that stores sperm behind the testicle may relieve the pain. The procedure seems to be most effective in relieving pain in men who have a cyst, a granuloma or a mass on the epididymis. […] Vasectomy reversal (vasovasostomy). Reversing the vasectomy will restore sperm to the ejaculate and may restore fertility. This procedure may relieve pain and pressure that occur with ejaculation. For some men, vasectomy reversal is more effective than the MDSC approach in relieving pain. […] Orchiectomy. Removal of the testicle is a last resort for men who do not respond to more-conservative treatments. Even after the testicle is removed, men sometimes feel a phantom limb pain in the area where the testicle used to be.

• #40

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

  Epididymectomy continues to remain a more popular approach compared to MDSC especially in Europe. […] The reported success rates with epididymectomy range from 50% to 92% and have been reported to produce a better result in relieving pain if a structural abnormality (cyst, granuloma or mass) was noted in the epididymis on examination or with ultrasonography. […] Vaso-vasostomy appears to be an intuitive solution to PVPS. […] However, these studies show that up to 100% of patients experience some improvement in pain scores, and complete resolution of pain have been reported to be as high as 50%-69%. […] Orchiectomy is considered the last resort in patients who do not respond to other means of therapy. […] On the basis of these results, the authors recommended inguinal orchiectomy as the procedure of choice for the management of chronic testicular pain when other management is unsuccessful.

• #41 Post-Vasectomy Pain Syndrome: Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/23048-post-vasectomy-pain-syndrome

  Post-vasectomy pain syndrome is a rare complication that can happen right after a vasectomy or months later. If treatments like medications dont ease symptoms, you may need a vasectomy reversal or a different surgery. […] Chronic pain from PVPS can be difficult to treat. If nonsurgical therapies dont provide adequate symptom relief, your healthcare provider may recommend surgery. A vasectomy reversal provides pain relief for more than 9 in 10 men. However, it also restores your fertility. Other surgical options vary depending on the underlying cause of your pain. […] Surgical treatments can be highly successful. A vasectomy reversal eases pain for as many as 9 in 10 men. About 3 in 4 men are pain-free after undergoing microdenervation (cord stripping). But unfortunately, some men continue to have pain after surgery.

• #42 Post-vasectomy pain syndrome – Wikipedia

  https://en.wikipedia.org/wiki/Post-vasectomy_pain_syndrome

  Post-vasectomy pain syndrome (PVPS) is a chronic and sometimes debilitating genital pain condition that may develop immediately or several years after vasectomy. Because this condition is a syndrome, there is no single treatment method, therefore efforts focus on mitigating/relieving the individual patient’s specific pain. […] Treatment depends on the proximate cause. In one study, it was reported that 9 of 13 men who underwent vasectomy reversal in an attempt to relieve post-vasectomy pain syndrome became pain-free, though the followup was only one month in some cases. Another study found that 24 of 32 men had relief after vasectomy reversal. […] Nerve entrapment is treated with surgery to free the nerve from the scar tissue, or to cut the nerve. One study reported that denervation of the spermatic cord provided complete relief at the first follow-up visit in 13 of 17 cases, and that the other four patients reported improvement. As nerves may regrow, long-term studies are needed. […] One study found that epididymectomy provided relief for 50% of patients with post-vasectomy pain syndrome. […] Orchiectomy is recommended usually only after other surgeries have failed.

• #43 Post-vasectomy pain syndrome

  https://johnsonmemorial.org/jmh-health/disease-conditions/con-20517005

  Epididymectomy. For men with pain of the epididymis, removing the C-shaped structure that stores sperm behind the testicle may relieve the pain. The procedure seems to be most effective in relieving pain in men who have a cyst, a granuloma or a mass on the epididymis. […] Vasectomy reversal (vasovasostomy). Reversing the vasectomy will restore sperm to the ejaculate and may restore fertility. This procedure may relieve pain and pressure that occur with ejaculation. For some men, vasectomy reversal is more effective than the MDSC approach in relieving pain. […] Orchiectomy. Removal of the testicle is a last resort for men who do not respond to more-conservative treatments. Even after the testicle is removed, men sometimes feel a phantom limb pain in the area where the testicle used to be.

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

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

  Either exclusively or in combination with pharmacotherapy, pelvic floor therapy and/or acupuncture may be offered to patients with PVPS. […] Failed pharmacotherapy and noninvasive modalities should trigger surgical intervention. 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. […] 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.

• #45

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

  Epididymectomy continues to remain a more popular approach compared to MDSC especially in Europe. […] The reported success rates with epididymectomy range from 50% to 92% and have been reported to produce a better result in relieving pain if a structural abnormality (cyst, granuloma or mass) was noted in the epididymis on examination or with ultrasonography. […] Vaso-vasostomy appears to be an intuitive solution to PVPS. […] However, these studies show that up to 100% of patients experience some improvement in pain scores, and complete resolution of pain have been reported to be as high as 50%-69%. […] Orchiectomy is considered the last resort in patients who do not respond to other means of therapy. […] On the basis of these results, the authors recommended inguinal orchiectomy as the procedure of choice for the management of chronic testicular pain when other management is unsuccessful.

• #46 Post-Vasectomy Pain Syndrome: Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/23048-post-vasectomy-pain-syndrome

  Post-vasectomy pain syndrome is a rare complication that can happen right after a vasectomy or months later. If treatments like medications dont ease symptoms, you may need a vasectomy reversal or a different surgery. […] Chronic pain from PVPS can be difficult to treat. If nonsurgical therapies dont provide adequate symptom relief, your healthcare provider may recommend surgery. A vasectomy reversal provides pain relief for more than 9 in 10 men. However, it also restores your fertility. Other surgical options vary depending on the underlying cause of your pain. […] Surgical treatments can be highly successful. A vasectomy reversal eases pain for as many as 9 in 10 men. About 3 in 4 men are pain-free after undergoing microdenervation (cord stripping). But unfortunately, some men continue to have pain after surgery.

• #47 Post-Vasectomy Pain Syndrome: Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/23048-post-vasectomy-pain-syndrome

  Post-vasectomy pain syndrome is a rare complication that can happen right after a vasectomy or months later. If treatments like medications dont ease symptoms, you may need a vasectomy reversal or a different surgery. […] Chronic pain from PVPS can be difficult to treat. If nonsurgical therapies dont provide adequate symptom relief, your healthcare provider may recommend surgery. A vasectomy reversal provides pain relief for more than 9 in 10 men. However, it also restores your fertility. Other surgical options vary depending on the underlying cause of your pain. […] Surgical treatments can be highly successful. A vasectomy reversal eases pain for as many as 9 in 10 men. About 3 in 4 men are pain-free after undergoing microdenervation (cord stripping). But unfortunately, some men continue to have pain after surgery.

• #48 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. […] Treatments for post-vasectomy pain syndrome include medication, surgical procedures like vasectomy reversal, physical therapy, and acupuncture. […] Some doctors will prescribe medication such as oral anti-inflammatories, injectable nerve blocks, or antidepressants, depending on the cause of the pain. In some cases, pelvic floor physical therapy or acupuncture can help. […] Vasectomy reversal is the most common and straightforward solution for those who find little success with medical management of post vasectomy pain. […] Studies show that 84% men with post vasectomy pain syndrome had resolution of pain following vasectomy reversal surgery. […] Some consider an epididymectomy, the surgical removal of the epididymis, the long tube where sperm is transported from the testes to the vas deferens. This procedure has a pain-relief success rate of 50% to 92%, but it eliminates the possibility of a vasectomy reversal down the line.

• #49 What are the 11 Treatment Options for Post Vasectomy Pain Syndrome (PVPS)? ⋆ DadsAgain.com

  https://www.dadsagain.com/articles/treatments-pvps/

  This is a 2 to 2.5 hour outpatient surgery under mild sedation when done correctly by an true expert, with very high chances as high as 90 to 95% success with total resolution of the pain or such dramatic reduction that most men happily get on with their life. […] It is important to know that in medicine, we all know that there are no guarantees how each persons body will respond to any treatment.

• #50 Post-Vasectomy Pain Syndrome: Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/23048-post-vasectomy-pain-syndrome

  Post-vasectomy pain syndrome is a rare complication that can happen right after a vasectomy or months later. If treatments like medications dont ease symptoms, you may need a vasectomy reversal or a different surgery. […] Chronic pain from PVPS can be difficult to treat. If nonsurgical therapies dont provide adequate symptom relief, your healthcare provider may recommend surgery. A vasectomy reversal provides pain relief for more than 9 in 10 men. However, it also restores your fertility. Other surgical options vary depending on the underlying cause of your pain. […] Surgical treatments can be highly successful. A vasectomy reversal eases pain for as many as 9 in 10 men. About 3 in 4 men are pain-free after undergoing microdenervation (cord stripping). But unfortunately, some men continue to have pain after surgery.

• #51 Post-vasectomy pain syndrome – Wikipedia

  https://en.wikipedia.org/wiki/Post-vasectomy_pain_syndrome

  Post-vasectomy pain syndrome (PVPS) is a chronic and sometimes debilitating genital pain condition that may develop immediately or several years after vasectomy. Because this condition is a syndrome, there is no single treatment method, therefore efforts focus on mitigating/relieving the individual patient’s specific pain. […] Treatment depends on the proximate cause. In one study, it was reported that 9 of 13 men who underwent vasectomy reversal in an attempt to relieve post-vasectomy pain syndrome became pain-free, though the followup was only one month in some cases. Another study found that 24 of 32 men had relief after vasectomy reversal. […] Nerve entrapment is treated with surgery to free the nerve from the scar tissue, or to cut the nerve. One study reported that denervation of the spermatic cord provided complete relief at the first follow-up visit in 13 of 17 cases, and that the other four patients reported improvement. As nerves may regrow, long-term studies are needed. […] One study found that epididymectomy provided relief for 50% of patients with post-vasectomy pain syndrome. […] Orchiectomy is recommended usually only after other surgeries have failed.

• #52

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

  Epididymectomy continues to remain a more popular approach compared to MDSC especially in Europe. […] The reported success rates with epididymectomy range from 50% to 92% and have been reported to produce a better result in relieving pain if a structural abnormality (cyst, granuloma or mass) was noted in the epididymis on examination or with ultrasonography. […] Vaso-vasostomy appears to be an intuitive solution to PVPS. […] However, these studies show that up to 100% of patients experience some improvement in pain scores, and complete resolution of pain have been reported to be as high as 50%-69%. […] Orchiectomy is considered the last resort in patients who do not respond to other means of therapy. […] On the basis of these results, the authors recommended inguinal orchiectomy as the procedure of choice for the management of chronic testicular pain when other management is unsuccessful.

• #53 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. […] Treatments for post-vasectomy pain syndrome include medication, surgical procedures like vasectomy reversal, physical therapy, and acupuncture. […] Some doctors will prescribe medication such as oral anti-inflammatories, injectable nerve blocks, or antidepressants, depending on the cause of the pain. In some cases, pelvic floor physical therapy or acupuncture can help. […] Vasectomy reversal is the most common and straightforward solution for those who find little success with medical management of post vasectomy pain. […] Studies show that 84% men with post vasectomy pain syndrome had resolution of pain following vasectomy reversal surgery. […] Some consider an epididymectomy, the surgical removal of the epididymis, the long tube where sperm is transported from the testes to the vas deferens. This procedure has a pain-relief success rate of 50% to 92%, but it eliminates the possibility of a vasectomy reversal down the line.

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

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

  The last resort for patients with debilitating chronic pain is orchiectomy, despite one study by Sweeney et al. stating that 80% of patients who underwent orchiectomy continued to experience pain. […] Our results from a systematic review and meta-analysis of all the available literature show much higher frequencies with the overall average being 15%, following scalpel vasectomy at 24% and after NSV at 7%. […] However, the incidence of PVPS is similar between the two techniques. Therefore, less invasive NSV should be considered as the preferred procedural method compared to the incisional scalpel approach to mitigate the complication of post-vasectomy pain.

• #55 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. 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. […] 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. Nonsurgical treatments include both pharmacotherapy and nonsurgical modalities to alleviate pain. Medical treatment usually begins with scheduled non-steroidal anti-inflammatory drugs (NSAIDs) for 4-6 weeks. If NSAIDs do not improve testicular pain, the second line medication recommended is a tricyclic antidepressant (TCA) or gabapentin.

• #56 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. […] 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. […] 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.

• #57 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

  Postvasectomy pain syndrome (PVPS) can be debilitating and is notoriously difficult to treat, often requiring a multidisciplinary approach. […] After the patient’s urologist suggested orchiectomy, his family medicine physician referred him for OMT. The OMT interventions, applied over a 4-month period, were directed at the lumbar spine, pelvis, pelvic floor, and lower abdomen. After treatment, the patient reported absence of testicular pain most of the time and described his quality of life as 10 times better. […] We hypothesize a myofascial or musculoskeletal contribution to some cases of chronic pain after vasectomy, making OMT a reasonable treatment component in a multidisciplinary approach to patients with PVPS. […] The OMT interventions included treatment of the lumbar spine, pelvis, pelvic floor, and lower abdomen during a period of 4 months (10 visits).

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

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

  The last resort for patients with debilitating chronic pain is orchiectomy, despite one study by Sweeney et al. stating that 80% of patients who underwent orchiectomy continued to experience pain. […] Our results from a systematic review and meta-analysis of all the available literature show much higher frequencies with the overall average being 15%, following scalpel vasectomy at 24% and after NSV at 7%. […] However, the incidence of PVPS is similar between the two techniques. Therefore, less invasive NSV should be considered as the preferred procedural method compared to the incisional scalpel approach to mitigate the complication of post-vasectomy pain.

• #59 No-Scalpel Vasectomy lowers risk of PVPS | Tri-Valley Vasectomy

  https://trivalleyvasectomy.com/vasectomy-procedure/navigating-post-vasectomy-pain-syndrome-how-no-scalpel-vasectomy-lowers-risks/

  PVPS is a chronic pain condition that can develop immediately or many years after a vasectomy. […] Treatment for PVPS initially involves non-surgical approaches, such as medications, physical therapy, and lifestyle modifications. However, if these do not provide adequate relief, surgical intervention may be necessary. In fact, vasectomy reversal and microdenervation of the spermatic cord have been shown to significantly alleviate pain in a majority of patients. […] Given the current understanding of PVPS, the most effective preventive measure is choosing a vasectomy technique that minimizes the risk. The no-scalpel vasectomy method has been shown to significantly lower the incidence of PVPS due to its less invasive nature, providing an effective strategy to prevent this chronic pain condition.

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

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

  The last resort for patients with debilitating chronic pain is orchiectomy, despite one study by Sweeney et al. stating that 80% of patients who underwent orchiectomy continued to experience pain. […] Our results from a systematic review and meta-analysis of all the available literature show much higher frequencies with the overall average being 15%, following scalpel vasectomy at 24% and after NSV at 7%. […] However, the incidence of PVPS is similar between the two techniques. Therefore, less invasive NSV should be considered as the preferred procedural method compared to the incisional scalpel approach to mitigate the complication of post-vasectomy pain.

• #61 About Post Vasectomy Pain Syndrome – Buenafe Clinic

  https://buenafeclinic.com/what-is-post-vasectomy-pain-syndrome/

  A closed-ended vasectomy could cause a congestive state in the epididymis from back pressure to the epididymis and testes. Some authors believe that by blocking both the upper and lower cut ends of the vas tube the normal passage of sperm from the penis and away from the epididymis and testes causes a build up of pressure, thus ensuing pain. Studies have shown that this situation can be prevented to a large degree by performing an open-ended vasectomy as performed by Dr. Buenafe. In carrying out an open-ended vasectomy, the lower or testicular end of the cut vas is left open, thereby allowing the sperm to drain out of the tube preventing a build up of pressure. […] Shorter term causes of post vasectomy pain include infection and post operative inflammation which tends to resolve itself with the appropriate medications. These shorter term causes rarely persists long enough to fall into the category of becoming chronic.

• #62 About Post Vasectomy Pain Syndrome – Buenafe Clinic

  https://buenafeclinic.com/what-is-post-vasectomy-pain-syndrome/

  Post Vasectomy Pain Syndrome is an uncommon occurrence that can happen to a small number of men after a vasectomy procedure. This syndrome can begin immediately after the vasectomy or many months or even years after the vasectomy has been completed. […] The frequency of this problem varies amongst given practitioners. Some studies reports as high as one third of men after vasectomy have some type of lingering discomfort. Other studies report that the frequency of post vasectomy pain is one case in thousands. Due to the wide variations in the incidence of post vasectomy pain in the practices of different vasectomy surgeons, it is important that each surgeon give their patients an accurate account of what the risks of post vasectomy pain syndrome would be in their specific practice. […] There are some speculative causes of post vasectomy pain syndrome in patients, which include: A “rough” surgery where significant amounts of tissue and nerves have been disrupted and/or tied that have caused lingering irritation of the nerves. While this may be a cause of post vasectomy pain syndrome, we believe that this would be less common in patients utilizing the services of an experienced doctor who has performed many vasectomy procedures with minimal side effects.

• #63 Scrotal Pain Syndrome (Post-Vasectomy Pain) — Metrovan Urology

  https://www.metrovanurology.com/scrotal-pain-syndrome-postvasectomy-pain

  Post vasectomy pain syndrome has a prevanence of 1-15% with severe pain present in 1-5% of pain. […] Specifically causes of post-vasectomy pain syndrome have altered or hyperacitve nerves in the scrotum. […] Treatment for Scrotal Pain Syndrome is varied and may include multiple therapies: […] Treatment of Scrotal Pain Syndrome has been most succesful with a mult-disciplinary approach using multiple modalities. […] Men with scrotal pain sydrome show up to a 60-70% response with multi-modal therapy. […] Medical therapy is often used to try and diminish the neuropathic up-regulation associated with scrotal pain syndrome. […] Non-steroidal anti-inflammatories such as Ibuprofen/Advil can be used. […] Antibiotics can sometimes be used for patients who have had chronic infections in the testicle or scrotum. […] Nerve blocks for scrotal pain has been used as a temporizing measure for scrotal pain. […] Rarely surgery is used to treat scrotal pain syndrome. […] The success of surgical treatment of scrotal pain syndrome can vary from 30-70%.

• #64 Scrotal Pain Syndrome (Post-Vasectomy Pain) — Metrovan Urology

  https://www.metrovanurology.com/scrotal-pain-syndrome-postvasectomy-pain

  Post vasectomy pain syndrome has a prevanence of 1-15% with severe pain present in 1-5% of pain. […] Specifically causes of post-vasectomy pain syndrome have altered or hyperacitve nerves in the scrotum. […] Treatment for Scrotal Pain Syndrome is varied and may include multiple therapies: […] Treatment of Scrotal Pain Syndrome has been most succesful with a mult-disciplinary approach using multiple modalities. […] Men with scrotal pain sydrome show up to a 60-70% response with multi-modal therapy. […] Medical therapy is often used to try and diminish the neuropathic up-regulation associated with scrotal pain syndrome. […] Non-steroidal anti-inflammatories such as Ibuprofen/Advil can be used. […] Antibiotics can sometimes be used for patients who have had chronic infections in the testicle or scrotum. […] Nerve blocks for scrotal pain has been used as a temporizing measure for scrotal pain. […] Rarely surgery is used to treat scrotal pain syndrome. […] The success of surgical treatment of scrotal pain syndrome can vary from 30-70%.

• #65

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

  Epididymectomy continues to remain a more popular approach compared to MDSC especially in Europe. […] The reported success rates with epididymectomy range from 50% to 92% and have been reported to produce a better result in relieving pain if a structural abnormality (cyst, granuloma or mass) was noted in the epididymis on examination or with ultrasonography. […] Vaso-vasostomy appears to be an intuitive solution to PVPS. […] However, these studies show that up to 100% of patients experience some improvement in pain scores, and complete resolution of pain have been reported to be as high as 50%-69%. […] Orchiectomy is considered the last resort in patients who do not respond to other means of therapy. […] On the basis of these results, the authors recommended inguinal orchiectomy as the procedure of choice for the management of chronic testicular pain when other management is unsuccessful.

• #66 Post-Vasectomy Pain Syndrome: Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/23048-post-vasectomy-pain-syndrome

  Post-vasectomy pain syndrome is a rare complication that can happen right after a vasectomy or months later. If treatments like medications dont ease symptoms, you may need a vasectomy reversal or a different surgery. […] Chronic pain from PVPS can be difficult to treat. If nonsurgical therapies dont provide adequate symptom relief, your healthcare provider may recommend surgery. A vasectomy reversal provides pain relief for more than 9 in 10 men. However, it also restores your fertility. Other surgical options vary depending on the underlying cause of your pain. […] Surgical treatments can be highly successful. A vasectomy reversal eases pain for as many as 9 in 10 men. About 3 in 4 men are pain-free after undergoing microdenervation (cord stripping). But unfortunately, some men continue to have pain after surgery.

• #67 Post-Vasectomy Pain Syndrome: Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/23048-post-vasectomy-pain-syndrome

  Post-vasectomy pain syndrome is a rare complication that can happen right after a vasectomy or months later. If treatments like medications dont ease symptoms, you may need a vasectomy reversal or a different surgery. […] Chronic pain from PVPS can be difficult to treat. If nonsurgical therapies dont provide adequate symptom relief, your healthcare provider may recommend surgery. A vasectomy reversal provides pain relief for more than 9 in 10 men. However, it also restores your fertility. Other surgical options vary depending on the underlying cause of your pain. […] Surgical treatments can be highly successful. A vasectomy reversal eases pain for as many as 9 in 10 men. About 3 in 4 men are pain-free after undergoing microdenervation (cord stripping). But unfortunately, some men continue to have pain after surgery.

• #68

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

  Epididymectomy continues to remain a more popular approach compared to MDSC especially in Europe. […] The reported success rates with epididymectomy range from 50% to 92% and have been reported to produce a better result in relieving pain if a structural abnormality (cyst, granuloma or mass) was noted in the epididymis on examination or with ultrasonography. […] Vaso-vasostomy appears to be an intuitive solution to PVPS. […] However, these studies show that up to 100% of patients experience some improvement in pain scores, and complete resolution of pain have been reported to be as high as 50%-69%. […] Orchiectomy is considered the last resort in patients who do not respond to other means of therapy. […] On the basis of these results, the authors recommended inguinal orchiectomy as the procedure of choice for the management of chronic testicular pain when other management is unsuccessful.

• #69

  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. […] This article reviews the current understanding of post-vasectomy pain syndrome, theories behind its pathophysiology, evaluation pathways, and treatment options. […] At present, the syndrome is widely accepted as post-vasectomy pain syndrome (PVPS). […] In this article, we aim to review the therapeutic intervention for this perplexing problem. […] Currently, there are no published data with good evidence regarding non-surgical intervention for PVPS. However, pharmacotherapy should be considered the first line followed by a series of spermatic cord blocks. Pelvic floor physical therapy, acupuncture, and a psychological evaluation may also be beneficial. Failing non-surgical treatment, repeating the vasectomy with wide excision of the severed ends, microdenervation of the spermatic cord, epididymectomy, vasectomy reversal or orchiectomy should be considered.

• #70 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. 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. […] 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. Nonsurgical treatments include both pharmacotherapy and nonsurgical modalities to alleviate pain. Medical treatment usually begins with scheduled non-steroidal anti-inflammatory drugs (NSAIDs) for 4-6 weeks. If NSAIDs do not improve testicular pain, the second line medication recommended is a tricyclic antidepressant (TCA) or gabapentin.

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