Testicular pain following vasectomy: a review of postvasectomy pain syndrome.

Since the late 1970s the definition and etiology of chronic testicular pain following vasectomy has been evolving, as have the names for this syndrome, including postvasectomy orchalgia (Shapiro and Silber, 1979), late postvasectomy syndrome (Selikowitz and Schned, 1985), congestive epididymitis (Schmidt and Free, 1978), chronic testicular pain (McMahon et al, 1992), and postvasectomy pain syndrome (McCormack and LaPointe, 1988). Today, the syndrome is generally recognized by the term postvasectomy pain syndrome (PVPS). Although the mechanism has not been proven, a number of studies have shown changes in the histology of the epididymis and the testis following vasectomy. Patients with PVPS generally present with orchalgia; pain with intercourse, ejaculation, or both; pain with physical exertion; and tender or full epididymides (Nangia et al, 2000). The theory that these symptoms are caused by infection has long since been discarded, due to the lack of response to antibiotics in these patients and absence of acute infection when epididymal and vasal sections are removed during surgery and analyzed histologically (Selikowitz and Schned, 1985; Chen and Ball, 1991). Instead, histologic studies of samples collected during vasovasostomy or epididymectomy have demonstrated a chronic inflammatory process that begins to explain the development of PVPS.