Donate

Epididymectomy is an effective treatment for scrotal pain after vasectomy


#1

BJU Int. 2000 Jun;85(9):1097-9.
Epididymectomy is an effective treatment for scrotal pain after vasectomy.
West AF1, Leung HY, Powell PH.
(117.8 KB)


#2

Who here has actually had this done? A well known urologist and pioneer in reversal in Portland told me that he has had patients who ended up with severe pain after this procedure. Curiously, when they want to sterilize wild lions, they do this procedure. The lions can still breed, but are infertile. But in the case of people, does anyone here know anyone who actually has had this done?


#3

Thats not worthy of the name study. The improvement part is also to subjective you could be dying from backpressure, get the epididimectomy and after 5 years end up with daily pain that is acceptable and still call it a substantial improvement. You need to be pain free and at least close to 99% of how you were before they performed the vasectomy to call a procedure really successful.


#4

I notice that the study says patients who had a “normal appearance of the epididymis on ultrasonography” did not have a successful surgery.


#5

“We removed your epididymis and on the ultrasound it is still there, we conclude that the operation was unsuccessful” No shit Sherlock!


#6

I compiled the below to a word doc I have of bits & pieces from a page that Vic posted a few years ago, Epi success rates are quite variable. If you are having an immunogenic reaction from leakage, then Epi would mean there is no way to revert and get rid of the reaction without and orchi, so I did not like the look of it over more conservative options.

Reversal success rate references:

Vasectomy reversal provides long-term pain relief for men with the post-vasectomy pain syndrome. J Urol. 2012 Feb;187(2):613-7. Horovitz D, Tjong V, Domes T, Lo K, Grober ED, Jarvi K. - improvement of pain occurred in 93% and 50% were rendered pain-free

Vasectomy reversal for the post-vasectomy pain syndrome: a clinical and histological evaluation. J Urol. 2000;164:1939–42. Nangia AK, Myles JL, Thomas AJ., Jr - 69% experienced full pain relief

Vasectomy reversal for treatment of the post-vasectomy pain syndrome. J Urol. 1997;157:518–20. Myers SA, Mershon CE, Fuchs EF. - 27 of 32 men had resolution of pain (84%)

Vasectomy Reversal For Post-Vasectomy Pain Syndrome: a Ten-Year Experience. volume 183, issue 4 of the Journal of Urology. Werthman P - 75% experienced full pain relief.

Epididymectomy for chronic scrotal pain , this precludes the reversal option:

Does surgery have a role in management of chronic intrascrotal pain?
Sweeney CA, Oades GM, Fraser M, Palmer M.
Urology. 2008 Jun;71(6):1099-102. doi: 10.1016/j.urology.2008.02.036. Epub 2008 Apr 24. - 32% resolution rate

Epididymectomy for post-vasectomy pain: histological review. Chen TF, Ball RY.
Br J Urol. 1991 Oct;68(4):407-13. - 50% resolution rate

Long-term outcome of epididymectomy for the management of chronic epididymal pain.
Hori S, Sengupta A, Shukla CJ, Ingall E, McLoughlin J.J Urol. 2009 Oct;182(4):1407-12. doi: 10.1016/j.juro.2009.06.020. Epub 2009 Aug 15. - 93% had less or no pain postoperatively

Epididymectomy is an effective treatment for scrotal pain after vasectomy.
West AF, Leung HY, Powell PH.
BJU Int. 2000 Jun;85(9):1097-9. - Of the 16 patients, 14 had excellent initial symptomatic benefit from epididymectomy

Denervation for pain success:
The incidence of post-vasectomy chronic testicular pain and the role of nerve stripping (denervation) of the spermatic cord in its management.AHMED,I., RASHEED, S., WHITE, C., & SHAIKH, N. (1997). British Journal of Urology, (79), 269–270. - 83% relief


#7

For interest Epidymectomy is often up selected in the UK as a National Health Service PVPS treatment as they think you are pulling a fast one for free fertility treatment if requesting a reversal for pain!


#8

I would beat the living crap out of any NHS fucker that tells me that I’m abusing the system after going to 8 urologists (12 visits, 3 operations in total) in the year after my vasectomy.


#9

It seems to be guidance at a trust / national level, as reversal is more usually for fertility and thus often not considered an NHS funded treatment, so much harder to get approved. Reversal is I believe also a more expensive surgery. I think it’s more a matter of general ignorance around pvp and the literature than anything else. Similar to underbriefing often seen on the chronic pain outcomes.


#10

So the NHS will try to force you to get an epidimectomy if they think you’re trying to pull a fast one with a reversal? What a bunch of assholes. That’s barbaric. Talk about genital mutilation.


#11

Hmm, I don’t want to over egg this, but if you look at a number of health trust guidelines that seems to be the case for many in the UK, vasectomy reversal is difficult to get approved for NHS funding because of the presumed fertility treatment angle, despite the NHS providing the original vasectomy surgery that caused the issues. There is also a presumption that you will want primarily to stay sterile over the pain problems, so Epi also is seemingly preferred for that reason. When I first spoke to a family GP about pain, medication and a possible Epi was the first thing discussed, then I started to read for myself a lot, and suspected I had an immune reaction so started chasing reversal.

I was offered an NHS reversal myself, by the same surgeon who performed my vasectomy, 11 months after the original surgery. I went and paid privately though, as I had trouble trusting the original surgeon, even if hadn’t made an error and I simply had a bad reaction, which later seemed to be the case. I also wanted to go to someone who did a very large volume of surgeries with full microsurgical technique and audited stats.


#12

There is no way in hell in would trust any old NHS urologist to perform a reversal on me. I would have a hard time in England period. I seek out the best doctors and surgeons my private insurance allows and I don’t know how it works in the UK but if I was limited in my choices because of some government beaurocracy I dont think I could handle that. I flew to Arizona to get my reversal and I live I Maryland.


#13

I flew from Northern Ireland to Nottingham to have my reversal and paid around ÂŁ3500 in total. It was genuinely the very best money I have ever spent though, apart from the add on self pay care we sought when my wife was carrying our children.

Again, I really don’t want to be winding people up here with this, as I know that severe pain from pvps is a complete horror show.

There are a few v good private UK reversal surgeons, in part because of the lack of available NHS funding in that surgical space, it has as a result produced a competitive market place in reversal with audited published statistics etc, which is more than the NHS usually gives you!

In its defence the NHS has saved both my life, and that of my wife in the past, all without insurance or any direct payment, along with many of my family members, it’s just really, really, really crap about recognising, warning and treating on pvps. From Vic’s past posts Canada’s national system is something similar where pvps is concerned.


#14

I’m probably being overly harsh and ignorant. It’s just that in the US I have zero faith in the government to manage something like healthcare reimbursement without bankrupting the country or destroying the quality of care.


#15

http://www.usdebtclock.org/

Your pretty bankrupt already :slight_smile: You just have to wait until China stops accepting your monopoly dollars…


#16

In the UK the NHS is usually viewed as almost sacrosanct as it saved so many lives, particularly of less well off people such as some of my own family since it was established as part of the new social state brought about after WW2. I know from talking to people from the US I have met the UK system seems crazy to them vs. the more self guided market based system there. There’s less choice and control, but universal access without payment for all at the point of use, wherever you happen to travel in the country.

The other side of that is that it’s a tax income chewing monster, which leads to seeking lower cost treatment options , some restriction of available treatments, and less granular solutions. Vasectomy reversals are a victim of this approach on some occasions, pvps reversals doubly so.

I don’t think you are being ignorant it’s just a really different healthcare culture over here from many other places.

While I can think like this now, when I was a peak pain levels I hated the NHS’s guts :slight_smile:


#17

We (Belgium) seem to have the best system, it’s bloody expensive but I can go to any doctor or specialist paying 25 euros for a standard visit. My vasectomy costed me 20 euros (720 to what you guys would call the NHS)


#18

I should mention that the Dr. who doesn’t like epididymectomy told me that sperm is still produced, but since it is completely trapped in the testicle, it causes even more pressure. But I will repeat my challenge: if you, or anyone you know, had epididymectomy and were cured of pain, or if it got worse, say something.


#19

True. My poor kids will have to deal with the mess we’ve created and keep creating.

I’ve hijacked your thread.

I think I would rather have no testicle than a mutilated one.


#20

Actually it was the first “treatment” they suggested to me :’) And so far it looks like a neuroma or 2 were the real cause of pain.