title: The incidence of post-vasectomy chronic testicular pain and the role of nerve stripping (denervation) of the spermatic cord in its management.
abstract: OBJECTIVE
  To assess the incidence of chronic postvasectomy testicular pain (CPTP) and evaluate the use of denervation of the spermatic cord in its management.
  
  
  METHODS
  A retrospective postal survey of 560 patients (mean age 36 years, range 25-55; mean time since vasectomy 19 months, range 8-39) who underwent vasectomy between July 1992 and December 1994 was carried out to determine the incidence of CPTP. A prospective study was conducted in a further group of 17 patients (mean age 43 years, range 34-60), who had had CPTP for at least one year, to evaluate the effectiveness of nerve stripping of the spermatic cord in relieving pain.
  
  
  RESULTS
  Of 396 replies, 108 (27.2%) patients complained of some testicular pain following their vasectomy operation. In 88 (82%) of these 108 patients the pain was brief and was not defined as CPTP, while 20 (19%) patients had pain for > 3 months; 33 (31%) patients required analgesics to control the pain. Of the 17 patients who underwent spermatic cord denervation, 13 reported complete relief of pain at their first follow-up visit and were discharged. Four patients had a significant improvement in the symptom score and were satisfied with the results.
  
  
  CONCLUSIONS
  There is a small but significant incidence of CPTP and patients should be warned of this possibility when counselled before operation. Denervation of the spermatic cord seems to be a viable surgical option for patients with CPTP who fail to respond to conservative measures.
authors.affiliation: Airedale General Hospital, Keighley, UK.
authors.forename: I
authors.initials: I
authors.lastname: Ahmed
authors.forename: S
authors.initials: S
authors.lastname: Rasheed
authors.forename: C
authors.initials: C
authors.lastname: White
authors.forename: N A
authors.initials: NA
authors.lastname: Shaikh
mesh_terms: D000328:Adult; D003714:Denervation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000209:etiology* / Q000601:surgery; D011446:Prospective Studies; D012189:Retrospective Studies; D013085:Spermatic Cord / Q000294:innervation*; D014659:Vasectomy / Q000009:adverse effects*