What are the possible late post-operative complications of no-scalpel vasectomy (NSV)?

Updated: Jan 19, 2016
  • Author: M David Stockton, MD, MPH; Chief Editor: Edward David Kim, MD, FACS  more...
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Answer

Answer

Epididymal congestion is noted by patients as swelling and tenderness surrounding the epididymis or testicle that is accentuated by movement or strenuous activities. On examination, the testicle is usually enlarged, tender, and with a slightly indurated epididymis; however, fever is not usually present. This condition is thought to be noninfectious and related to vascular and lymphatic congestion. The application of heat and use of NSAIDs usually resolves symptoms within a week. If fever, elevated white count, or accentuated redness or tenderness is found, local infection should be considered.

A sperm granuloma may develop. This typically occurs during the second or third postoperative week and involves up to 25% of patients. This complication should be considered if, on examination of the patient, a small, palpable, pea-sized nodule is found at the testicular end of the transected vas. Once again, NSAIDs are used to resolve this problem, though persistent pain sometimes requires surgical removal of the nodule.

Development of a persistent pain syndrome affects a very small number of postvasectomy patients (approximately 1 per 1000 patients, according to McCouaghy [15] ). Even so, most of these patients state they do not regret having had the procedure. Patients often question whether undergoing a vasectomy will change their sexual potency or performance. In outside studies and in this author’s experience, the reduced fear of pregnancy and increased ease of spontaneous intercourse usually results in improved, rather than diminished, sexual function.

While conservative therapies are often effective for treating post-vasectomy pain syndrome, refractory cases may be treated with vasectomy reversal. In a recent series from Canada, 13 of 14 men who underwent vasovasostomies experienced an improvement in pain and quality of life. Half of the patients were rendered pain-free, signifying vasectomy reversal as an effective treatment for the post-vasectomy pain syndrome. [16]

At one time, increased instance of heart disease or prostatic cancer in patients who underwent vasectomy had been considered. According to long-term follow-up studies of patients who have undergone vasectomy, such increased instances are not evident. [17] A 2002 study by Cox et al found no increased risk of prostate cancer in these patients even 25 years after the procedure. [18]


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