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