A comparison of epididymectomy with vasectomy reversal for the surgical treatment of postvasectomy pain syndrome

Abstract

PURPOSE: To compare the outcome of epididymectomy and vasectomy reversal (VR) in patients with postvasectomy pain syndrome (PVPS) who required surgical treatment. METHODS: A total of 50 patients with PVPS who underwent epididymectomy or VR between January 2000 and January 2010 were included retrospectively. Of these, 36 (72.0%) patients completed the study questionnaire. These 36 patients completed the questionnaire either during attendance at the outpatient clinic or during a telephone interview. Twenty patients (22 cases) underwent epididymectomy, and sixteen patients (17 cases) underwent VR. Analyses were performed for (1) preoperative clinical findings, (2) preoperative and postoperative visual analogue pain scale (VAPS) scores, (3) patency and pregnancy rate in VR group, and (4) patient satisfaction with surgical treatment. RESULTS: The mean age was 48.28 ± 11.27 years, and the mean period of follow-up was 3.58 years (0.15-10.03). The mean VAPS score was 6.78 ± 0.93 preoperatively and 1.13 ± 0.72 postoperatively (p < 0.001). The difference in the mean preoperative and postoperative VAPS scores was 6.00 ± 1.34 (3-8) in the epididymectomy group and 5.50 ± 1.03 (4-8) in the VR group. However, this difference was not statistically significant (p = 0.227). No significant difference in satisfaction with surgical outcome was observed between the epididymectomy and the VR groups (p = 0.124). CONCLUSIONS: In PVPS patients requiring surgical treatment, no significant difference was observed between the epididymectomy and VR groups in either the reduction in pain or the degree of patient satisfaction with surgical outcome. Selection of the optimal surgical procedure may be dependent on specific patient characteristics.