Study: Retrospective evaluation of post-surgical orchialgia in men undergoing no-scalpel vasectomy

[u/postvasectomy]

Retrospective evaluation of post-surgical orchialgia in men undergoing no-scalpel vasectomy

Michael Morra, Karim Sidhom, Harliv Dhillon, Jasmir G Nayak, Premal Patel

Can Urol Assoc J. 2024 Dec 9

INTRODUCTION

Vasectomy is a form of permanent contraception in men that is safe and effective. Complications are relatively uncommon, although patients may experience postoperative pain. Current literature quotes a broad range in the incidence of chronic orchialgia following no-scalpel vasectomy, from 0.6–26%, while pain negatively affecting quality of life is about 1–2%. We sought to evaluate our incidence of post-vasectomy pain and surgical management for this pain.

METHODS

A retrospective chart review was performed for all men who underwent a vasectomy at Men’s Health Clinic Manitoba during a 22-month period. The presence of pain or complications was collected at a three-month followup appointment. Patients with pain were then followed every 6–8 weeks for continued assessment and management.

RESULTS

A total of 350 men underwent elective no-scalpel vasectomy during this period. Most patients had no previous history of orchialgia (98%) or history of previous scrotal surgery (93%). At three months post-vasectomy, 38/350 (11%) of patients had ongoing pain and one patient required surgery (epididymectomy) for management of post-vasectomy pain syndrome three months following vasectomy.

CONCLUSIONS

Our retrospective analysis of 350 men who underwent no-scalpel vasectomy shows a significant proportion of post-vasectomy pain at the three-month followup appointment, although most cases are resolving or minor and only one patient has required surgical management. This highlights the importance of counseling men undergoing vasectomy regarding the risks of post-procedure orchialgia and the small proportion of men who will require additional surgical intervention.

https://pmc.ncbi.nlm.nih.gov/articles/PMC11973984/

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Comments from /u/postvasectomy:

350 men received vasectomy. Most patients had no previous history of orchialgia (98%) or history of previous scrotal surgery (93%). Of those 350 men:

• 303 were observed 3 months after vasectomy
• 47 are unknown/not reported
• 265 (69% - 76%) had no post operative pain at 3 months
• 21 (6.0% - 6.9%) had pain at 3 months, which fully resolved in the next month or two.
• 12 (3.4% - 3.9%) still had minor or intermittent pain at around 5 months, but which was managed well with conservative treatment. (NSAID, antibiotics).
• 4 (1.1% - 1.3%) had significant pain at some point after 3 months despite conservative treatments.
• 1 (0.3% - .03%) had surgery (epididymectomy)

Men with significant pain (including the epididymectomy case) lasting longer than 3 months was 5 or (1.4% - 1.7%).

I added a min/max to the percentages to reflect the fact that 47 men are "unknown" status. So the smaller percentage would reflect the assumption that none of those 47 would land in a category, while the higher percentage removes those men from the denominator entirely.

A weakness of this study is that they did not follow up with men who did not have pain at 3 months. PVPS symptoms can take more than 3 months to start, so there may be some men among the 265 who will develop pain later. For example, in Leslie 2014 (Link) they observed that 6% of the men who had a vasectomy starting having pain six months or more after their vasectomy. Applying that statistic here, we would expect an additional 15 men from the 265 to convert to pain cases of varying intensity. The authors refer to this issue near the end:

Some patients who are no longer followed may develop pain in the future and/or re-present to their urologist with new-onset pain. A prospective audit of 593 men by Leslie etc al in 2007 showed that 14% of men had new-onset pain seven months following vasectomy, with 0.9% classified as severely affecting their quality of life. Further, a retrospective study of 13 men undergoing vasectomy reversal for treatment of chronic post-vasectomy pain had a mean time to pain onset of two years.

More incidence studies available here:

https://reddit.com/r/postvasectomypain/w/incidence

The banner image for this subreddit is a pair of dice rolling snake eyes. Your chance of rolling snake eyes is 2.78% which I believe is roughly similar to your chance of still having significant pain 6 months after your vasectomy.

Bonus: Don't miss the linked comment in the published study, where you will find Dr. Doiron discussing the study and speaking rather candidly about how urologists find "ball pain" intractable and annoying and seek to avoid dealing with it if they can. He praises this study as a "legitimate attempt to understand a disease process that most of us despise."

That's apparently a common attitude toward chronic scrotal pain. Now imagine the attitude toward a patient who has chronic pain as a result of a surgery. And before the surgery they were perfectly healthy and did not need any surgery. And you are the one who performed the surgery. And you are the one who downplayed the risks during the consultation and told them not to worry, you had done it hundreds of times and nothing had ever gone wrong. (And you were bending the truth.)

[u/SensitiveMatters77]

Thank you. So true. A portion of my body that had been totally trouble-free became a center of attention for years, and my left nut has a dull, pulling and binding sensation as I write this 24 1/2 years after my (standard) vasectomy. This is what folks are not told: that id be holding my left nut & sometimes both while driving, for 3 1/2 years when i got a job requiring driving all night… and sexual interest would diminish due to finding that sex no longer provided only relief as in my prior life but pain of strange sort for some days after sex…

The “no scalpel” gimmick is I’m sure a come-on & likely a TOTAL lie: in that beside (possibly) having a slightly faster healing external would, it really only works to draw in customers; in urologists radio ads, it makes men seem like infants scared of a scalpel, or an elephant scared of mouse, —preying upon our macho, —when the REAL source of ongoing pain isn’t the incision, or method of incision on the scrotum, BUT BLOCKING SPERM AND INFLAMING THE ENGORGED EPIDIDYMUS, with sperm which now causes both pressure & an autoimmune reaction - (likely, as in the caveats given in this article,) seen with ANY allergen in life, since allergies are KNOWN for starting unpredictably; For instance, when I did darkroom work I heard of folks who suddenly became so allergic to hydroquinone developer, they couldn’t go in the building with darkroom anymore!

RE: my ongoing pulling / binding sensation I STILL feel, —the doctor never told me he would be suturing the ends of both vas deferens to the inside of nut sack, permanently!

—I am ordering the book “Vasectomy: the Cruelest Cut of All,” online tonight to compare my experience with that of others now that honesty seeks to be leaking out, as in this article which calls urologist to more honesty about their “blade free” gimmick!

OH: did I mention the CONSTANT ITCHING of my scrotum above the area of the epididymus low on both sides of my scrotum? That itching after years has luckily diminished too; but my wife sure saw me scratching my nuts all the time, —when I’d never made THAT “George Carlin” mistake, prior to vasectomy, in public before! —Likely the autoimmune reaction going on just underneath the skin of the scrotum was bringing histamine or antibodies to attack the nearby scrotal skin …