Wondering if any of you recently went to Dr. Rosenblum for help with PVPS?
He sounds like a very careful pain specialist and talks about for example doing nerve blocks under ultrasonic guidance.
His recent podcast episode highlights PVPS after he met a man with PVP that did not get better after a couple of sperm granulomas were removed.
You can practically hear him shaking his head in disbelief as he reads the description of the changes to the body that occur post vasectomy:
I was in the office yesterday and a patient came in with a unique problem that I have to admit I have’t really seen before and this problem was that of post operative vasectomy pain.
Just to give a little review, I found an article that goes over this. This is mainly from the genitourinary literature as opposed to the pain management literature however I think it’s still important to go over this.
So they go in to talk about how it’s a well tolerated procedure in general, it’s also of course part of the whole family planning thing and about 42 million couples worldwide, or men from those couples, go through this.
After vasectomy, changes can occur in all areas of the genital track which are proximal to the vasectomy site. Adverse testicular histology after vasectomy has been reported in animals that they studied. They found increased phagocytosis of the Sertoli cells … there’s quantitative morphometric analysis of testicular histology in men after the vasectomy will show dilatation of the seminiferous tubules, interstitial fibrosis, and reductions in the seminiferous cell population
Doesn’t sound fun. I don’t think I would do this.
Vasectomy disrupts the blood testis barrier resulting in detectable levels of anti-sperm antibodies in men. There are long term effects of vasectomy on the humoral antibody response knowin instance of agglutinating antibodies increase to 60 percent by four years after vasectomy. It doesn’t appear to lead to any cell mediated immunity to sperm antigens.
Now this doesn’t really sound great, to be honest. I don’t know if it’s clinically significant in general, but this… I don’t like the idea of that.
The causes of post vasectomy pain syndrome still are controversial. There are some theories saying there’s obstruction and dialation of the epididymal duct producing interstitial fibrosis. The other suggestion is perineural fibrosis and inflammation after the rupture of the epididymal ducts, extravasation of the spermatazoa around the epididymal tubules at the site of the vasal transection and the nerves in the area can become fibrous, distorted, there can be lymphatic infiltration … a different degree of local fibrosis after the inflammatory response and the varying extent of epididymal compression can also cause the subjective scrotal pain that many patients will descrribe.
This does not sound like something fun.