Post Vasectomy Pain Forum

Proposed Epididymectomy

Yesterday, my urologist proposed my having an epididymectomy on the left testicle while he was going over the results of the scrotal ultrasound he had ordered.

The ongoing issue with the epididymitis wasn’t intended to be a topic of conversation with him. About a year and a half ago, a epidermoid cyst developed in the area of the perineum. I thought by treating it with topical medications, for acne, that I could get rid of it, but it instead had worsened. The pain finally drove me to see my PCP, and I was referred to a dermatologist.

The dermatologist wanted nothing to do with the situation–he had me pull my scrotum up while he peered at it from about three feet away, declared he saw nothing wrong and abruptly left the exam room. So…yeah…I won’t be going back there. I’m not sure what his issues were. My PCP professed to be surprised at his reaction.

So then my PCP referred me to the urologist. He examined me and quickly zeroed in the fact I have dual hydroceles, and he wanted to focus treatment on those. I held my ground though, and insisted that the epidermoid cyst was all I was seeking treatment for. He sent me for an ultrasound.

The ultrasound report shows that, in addition to the dual hydroceles, and the epidermoid cyst which now has developed a sinus tract leading into the subcutaneous tissues, the left epididymis has “coarse clustered calcifications, could be secondary to prior surgery, trauma or chronic left epididymitis.”

So, he proposed, in addition to the excision of the epidermoid cyst, that I undergo an epididymectomy on the left testicle. I was startled, really, by what seemed to me to be such a drastic step. I asked him where the sperm cells in the left testicle would go after the epididymectomy, and he looked a little blank for a moment and said, “Well, the sperm cells will just die, inside the testicle.” I rather sharply responded that I felt that would just make the situation worse, not better. But then, trying to smooth over my tense remark, I told him I’d think about it.

A scheduler is going to call me next week. I’m going to read up on the topic of epididymectomies, and try to reach a reasonable decision. I’d like for the pain in the area of the left testicle to go away, but I certainly don’t want to make a mistake and end up with a bad result.

So, I’m just sort of thinking out loud here. I’d welcome any observations or advice. Thanks.

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Sorry you are in this position mate. I only have one comment mate and that would be to the biggest no to an epididymectomy. They don’t take the pain away in fact they make it worse., and if they make a mistake and damaged your blood supply then your testicle will shrink. The other thing is an epididymectomy if it doesn’t work the pain stays the next only option is to loose your testicle. Mate do your homework and fully research an epididymectomy they are a barbaric surgery.


Agreed. Epididymectomy should be at the bottom of the list or things to try. Personally, I’d remove the testicles before I’d remove the epididymis.


I actually was originally scheduled to have an epididymectomy but instead chose to remove the testicle. It was the best decision ever.

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I would never recommend an epididymectomy to anyone for numerous reasons - including potential ethics. But, to each his own.

Also, based on everything I am aware of it would seem that epididymectomy has a very low success rate ~30-50%, and it seems to have a significant yet unknown (as a whole) chance of making things worse.

Keep in mind that there are a ~couple/few epididymectomy success stories on this site. The success story below always comes to mind, but there are a ~few others if one takes the time to look for them.

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Is the pain from the cyst bothering your or is it your epi? If there is pain in your epi, is it that bad? It would seem logical to do the cyst first and then wait to recover and reassess how you feel. You have multiple issues going on from what I’m gathering and they are not related. The cyst is not on your testes right? It’s in your perineum.

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The epidermoid cyst is in the perineum. It is, at times, really painful, to the point where it can make it difficult for me to walk. That was all I wanted the urologist to focus on (since the dermatologist I was initially referred to seemed to be so horrified at having to view my genitalia).

Both the epididymis structures on each testicle have been chronically inflamed over the years; I have “blowouts,” on one or the other side every three months, on average.

When I initially tried to see about getting the epididymitis cleared up, many years ago, I was unfortunately referred to a mean, nasty, urologist who insisted the ongoing inflammation had nothing to do with the vasectomy, and presumptuously declared that I probably had some form of an STD. He performed a battery of tests, including a painful “milking,” of the prostate gland, and no trace of an STD was found. I had told him I was divorced and not sexually active–I guess he didn’t believe me. Anyway, all that resulted from seeing him was his finally giving me the advice to avoid spicy foods.

I’ve made a decision not to have the epididymectomy as suggested by my current urologist. In all honesty, I think the current urologist is simply trying to find ways to increase his revenues. I have lived with the ongoing epididymitis for decades, and see no advantage of having him in there removing any delicate structures, and damaging the nerves and/or blood supplies to the testicle.

Per the ultrasound, both testicles are showing up with “heterogenous” textures, on the scans. I had to look that word up. From what I have been able to gather, both testes are showing signs of extensive internal damage. However, despite the heterogenous textures, both testicles are still within normal limits. I also have bilateral hydroceles.

All I am going to have the current urologist do, is to remove the epidermoid cyst, along with the associated sinus tract. After that is all healed up, and I’m able to walk normally again and get some exercise, I expect I’ll more or less be back to normal and I’m going to ignore the other issues unless they worsen and start to interfere with my life.

Figured I would elaborate a bit just to give anyone an idea of just how screwed up the information we are supposed to rely on really is.

From this link…

There were no significant aetiological differences between groups. In group one, 87.5% were cured with the remainder improved. Sixty-seven per cent of group two had a satisfactory outcome. Of group three, 20% were cured and a further 33% improved.

From this link…

Of the 16 patients, 14 had excellent initial symptomatic benefit from epididymectomy. At 3-8 years afterward, nine of 10 patients interviewed had a sustained improvement of their scrotal pain.

From this link…

The results showed that 50% of the post-vasectomy group were cured by simple epididymectomy.

Epididymectomy was performed on 10 men with intractable post-vasectomy pain, on 7 with chronic epididymo-orchitis and 7 with epididymal cysts. The vasectomy patients had pain of mean 6 years duration, 6 months-20 years after surgery. In 9 the pain was a constant, dull ache. 5 had unilateral, and 5 bilateral epididymectomy. Only 5 were relieved of pain: 1 subsequently had orchidectomy with symptomatic improvement. The other 4 were offered orchidectomy.

From this link…

Of the 34 procedures, 17 were left sided, 7 right sided, and 10 were bilateral; 25 had been performed for postvasectomy pain and 5 for obstruction related to hernia repair. Of the 44 cases, 31 (70%) reported no pain. Of the 13 still with pain, 8 (62%) reported less pain. Also, 90% were very satisfied or satisfied with their choice to undergo epididymectomy. We found excellent results after epididymectomy, especially for the indication of postvasectomy pain.

From this link…

In an attempt to rectify this, I underwent a right-sided epididymectomy in 2001. The chance of successful pain relief was 30%.

From this link…

Success rates of conservative and surgical measures including epididymectomy and orchiectomy rarely exceed 55–73% and 10–40%, respectively.

A wide variety of various success rate statistics, including epididymectomy statistics can be found in the 2016 pvps overview below.

An overview of the management of post-vasectomy pain syndrome;year=2016;volume=18;issue=3;spage=332;epage=337;aulast=Tan

In that random sample of studies, the success rate varies from ~20% to ~90%. Some literature makes epididymectomy sound like a no brainier and others make it sound pretty damn iffy at best.

This website definitely has a sample bias. There are a ~few epididymectomy success stories on this site, but epididymectomy as a whole reviews rather poorly on this site. Some of those men had a vasectomy and others did not.

I won’t start posting denervation links, heh. There was some denervation statistics in several of the links above. That procedure is generally advertised as another miracle cure with a very high success rate. It’s unfortunate that in all my years reading pain forums like this one, I just haven’t seen anything remotely close to the typical advertised ~success rate. Statistically speaking (as advertised), denervation should hold the title of champion on websites like this one, but it certainly doesn’t. It’s certainly possible that sample bias is to blame again. Whatever the case, in ~11+ years, I haven’t seen a pile of denervation success stories either. TBH, I personally know of few (shrug).