Korean J Urol.  2011 Nov;52(11):782-786.

Associations of Ultrasonographic Features with Scrotal Pain after Vasectomy

• Cho SH
• Min SK
• Lee ST

Abstract

PURPOSE
Scrotal discomfort is a recognized complication of vasectomy, but the natural history and incidence of this problem are uncertain. The typical ultrasonographic changes after a vasectomy primarily include epididymal thickening and epididymal tubular ectasia with diminished blood flow in the epididymis. We prospectively studied the differences in the ultrasonographic features of the testis and epididymis between patients with and those without scrotal discomfort after vasectomy.
MATERIALS AND METHODS
We prospectively assessed pain scores in 178 men who underwent outpatient bilateral no-scalpel vasectomy at our institution between January 2009 and December 2010. At 2 months after vasectomy, we evaluated the postoperative scrotal pain questionnaire and scrotal ultrasonographic features for patients who returned for semen analysis. On the basis of the scrotal information, we investigated the potential relationships between scrotal pain or discomfort and scrotal ultrasonographic features of both testes and epididymides.
RESULTS
The average age of the 114 men was 36.3 years (range, 29 to 53 years). group 1 (n=23), which reported scrotal pain or discomfort, showed no significant mean differences in the maximal diameter of the head of the epididymis when compared with group 2 (n=91), who had no scrotal pain or discomfort. Also, the width of the body of the epididymis between the two groups showed no significant differences.
CONCLUSIONS
There were no significant differences in ultrasonographic features according to the presence of chronic scrotal discomfort after vasectomy. Therefore, causes of scrotal pain other than obstruction may need to be considered after vasectomy.

Keyword

Color doppler ultrasonography; Epididymis; Vasectomy

MeSH Terms

Dilatation, Pathologic
Epididymis
Head
Humans
Incidence
Male
Natural History
Outpatients
Prospective Studies
Semen Analysis
Testis
Ultrasonography, Doppler, Color
Vasectomy

Figure

• 

  FIG. 1 Flow chart of the participants. VAS: visul analogue scale.

• 

  FIG. 2 Longitudinal sonography of right testis and epididymis before vasectomy and 2 months after vasectomy show increase in thickness of epididymis. (A) Largest diameter of the head of the epididymis. (B) Diameter of the body of the epididymis posterior to the proximal third of the testis.

Reference

1. Selikowitz SM, Schned AR. A late post-vasectomy syndrome. J Urol. 1985. 134:494–497.

2. McMahon AJ, Buckley J, Taylor A, Lloyd SN, Deane RF, Kirk D. Chronic testicular pain following vasectomy. Br J Urol. 1992. 69:188–191.

3. Ahmed I, Rasheed S, White C, Shaikh NA. The incidence of post-vasectomy chronic testicular pain and the role of nerve stripping (denervation) of the spermatic cord in its management. Br J Urol. 1997. 79:269–270.

4. Davis BE, Noble MJ, Weigel JW, Foret JD, Mebust WK. Analysis and management of chronic testicular pain. J Urol. 1990. 143:936–939.

5. Holden A, List A. Extratesticular lesions: a radiological and pathological correlation. Australas Radiol. 1994. 38:99–105.

6. Sweeney P, Tan J, Butler MR, McDermott TE, Grainger R, Thornhill JA. Epididymectomy in the management of intrascrotal disease: a critical reappraisal. Br J Urol. 1998. 81:753–755.

7. Reddy NM, Gerscovich EO, Jain KA, Le-Petross HT, Brock JM. Vasectomy-related changes on sonographic examination of the scrotum. J Clin Ultrasound. 2004. 32:394–398.

8. Choe JM, Kirkemo AK. Questionnaire-based outcomes study of nononcological post-vasectomy complications. J Urol. 1996. 155:1284–1286.

9. Shapiro EI, Silber SJ. Open-ended vasectomy, sperm granuloma, and postvasectomy orchialgia. Fertil Steril. 1979. 32:546–550.

10. Schmidt SS, Free MJ. The bipolar needle for vasectomy. I. Experience with the first 1000 cases. Fertil Steril. 1978. 29:676–680.

11. McCormack M, Lapointe S. Physiological consequences and complications of vasectomy. Can Med Assoc J. 1988. 138:223–225.

12. Christiansen CG, Sandlow JI. Testicular pain following vasectomy: a review of postvasectomy pain syndrome. J Androl. 2003. 24:293–298.

13. West AF, Leung HY, Powell PH. Epididymectomy is an effective treatment for scrotal pain after vasectomy. BJU Int. 2000. 85:1097–1099.

14. Choi HS, Hong JW, Kang SJ, Shin SJ. Ultrastructural changes of human testis after vasectomy. Korean J Urol. 1993. 34:528–534.

15. Nangia AK, Myles JL, Thomas AJ JR. Vasectomy reversal for the post-vasectomy pain syndrome: a clinical and histological evaluation. J Urol. 2000. 164:1939–1942.

16. Myers SA, Mershon CE, Fuchs EF. Vasectomy reversal for treatment of the post-vasectomy pain syndrome. J Urol. 1997. 157:518–520.