title: Post-vasectomy pain syndrome:  clinical features and treatment options.
abstract: BACKGROUND
  Post-vasectomy pain syndrome (PVPS), defined as chronic epididymal pain that is continuous or recurrent in the absence of proven epididymal or testicular infection, has become more common as the number of vasectomies performed rises.  With more than four million vasectomies performed annually, the prevention and treatment of this condition becomes more important.  Multiple theories have been proposed as a potential etiology of this condition, and along with this have come multiple modalities of treatment.  With the uncertainty surrounding the etiology of this syndrome, the aims of treatment are varied and are described and analyzed in this review.
  
  
  METHODS
  A literature review was conducted to ascertain the various theories explaining the source of the discomfort in this syndrome, along with several treatment modalities, both medical and surgical.
  
  
  CONCLUSIONS
  Options for the management of PVPS are rapidly expanding.  Among the existing surgical options that include spermatic cord denervation and vasovasostomies, testosterone has emerged as a potential medical therapy with some promising results.  Our review of the literature reveals the etiology of PVPS is still uncertain, as multiple theories still prevail.  However, progress has been made in the development of additional medical therapies that could provide some relief for patients who are unwilling to accept the risks of surgery.  Nevertheless, the importance of counseling patients of the risks of PVPS with vasectomy cannot be overstated.  Through review of the pathophysiology of this condition and treatment options including conservative approaches, topical therapies, denervation of the spermatic cord, and surgical approaches, a comprehensive therapeutic approach can be offered to affected patients.
authors.affiliation: Division of Urology, Robert C. Byrd Health Science Center, West Virginia University, Morgantown, West Virginia 26505-9238, USA.
authors.forename: Chad
authors.initials: C
authors.lastname: Morley
authors.forename: Aimee
authors.initials: A
authors.lastname: Rogers
authors.forename: Stanley
authors.initials: S
authors.lastname: Zaslau
mesh_terms: D000700:Analgesics / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D004822:Epididymis / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D009919:Orchiectomy; D010149:Postoperative Pain / Q000209:etiology* / Q000628:therapy*; D013085:Spermatic Cord / Q000294:innervation / Q000601:surgery; D014659:Vasectomy / Q000009:adverse effects*; D014669:Vasovasostomy
chemical_list: D000700:Analgesics; D000900:Anti-Bacterial Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal