“Pains” after a vasectomy…is it phantom?

Can be. Post surgical issues of testicular or scrotal procedures are complicated by the fact that the patient can see and feel the area of healing. In other words you can’t see or feel the area of healing of an appendectomy. In addition the testicles move around and this too keeps the fact that something has been done heavy on the mind of the male patient. So many times I’ll see  a patient after a vasectomy and they will tell me that one or both of their testicles are swollen. Commonly I examine them and everything is normal. I can only deduce that the post surgical changes  brought about by cutting the vas tube and sealing it has set in motion a chain of events that causes discomfort and is perceived by the patient as being “swollen.” 

From Vasectomy.com-Dr. McHugh opines.

The most common uncommon risks of having a vasectomy.

At the end of each vasectomy consultation and then after the vasectomy has been performed I tell the couple this, “The most important thing I will tell you is that you must not have unprotected sexual activity until we prove there are no sperm. It usually takes about 30 ejaculation to clear the sperm from the tube beyond the vasectomy site. In America approximately 50% of the men who have had a vasectomy will not get checked to be sure they are clear. You don’t have my guarantee until this has been done.” 

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Vasectomy follow up? Nearly one half of men never submit a post vasectomy semen specimen.

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Patient Non-Compliance With Vasectomy Follow-Up

Urology – September 30, 2013 – Vol. 30 – No. 10

Nearly 50% of patients do not perform post-vasectomy requested semen analysis.

Article Reviewed: Compliance With Semen Analysis. Duplisea J, Whelan T: J Urol; 2013;189 (June): 2248-2251.

Background: Nearly half a million men undergo vasectomy in the United States each year. While this is generally a straightforward procedure, it is not 100% successful. Post-vasectomy semen analysis helps the physician confidently determine if the procedure was successful, but no consensus exists to guide post-vasectomy semen analysis routine; the 2012 AUA guidelines suggest a single negative sample performed 8 to 16 weeks post-procedure, and <100,000 sperm/mL (non-motile) is considered a success. Patient compliance with post-vasectomy semen analysis is low and few studies review the reasons for poor compliance.

Objective: To determine which men are more or less likely to comply with requested post-vasectomy semen analysis based on demographic data.

Design/Methods: The authors performed a retrospective review of 946 men undergoing vasectomy at a single institution/single surgeon performed between January 2002 and December 2009. For this particular surgeon, post-vasectomy semen analysis was requested for 2 samples 16 weeks after vasectomy. The information was reiterated during vasectomy and written instructions were provided. The surgeon removed a piece of vas for pathologic analysis.

Results: The mean age of vasectomy patients was 33.6 years and they had a mean of 2.15 children before vasectomy. Over 80% of men were married and the complication rate was 3.4%. Complications were mostly hematoma and sperm granuloma. Vasectomy was repeated in 4 men, 3 of whom requested the repeat due to persistent non-motile sperm. Nearly 50% of men submitted no samples (48%) and 16% only submitted 1 sample. Men who were noncompliant tended to be aged <34 years, had ≥3 children, and did not have complications. Based on further logistic regression analysis, only an increased number of children was predictive of noncompliance.

Conclusions: Men with more children, of younger age, and without complications tend to be less likely to submit a post-vasectomy semen analysis. While the best protocol for post-procedure evaluation remains to be determined, increasing compliance is in the best interest of the physician.

Reviewer’s Comments: The most recent AUA guidelines do not suggest that pathologic analysis is necessary during a vasectomy, making post-vasectomy semen analysis the determinant of success. Unfortunately, as nearly all urologists experience, the majority of patients are not compliant with post-vasectomy semen analysis. The authors requested 2 post-vasectomy semen analysis samples and this was only completed by 36% of patients. Based on the guidelines, only 1 patient truly required a repeat procedure. Even with low failure rates, vasectomy remains a frequently litigated urologic procedure and physicians want to ensure success. As much as can be reiterated to the patient, obtaining a single semen analysis at least 8 weeks post-procedure should be the goal of all physicians performing vasectomy.(Reviewer–Gregory Lowe, MD).