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INTRODUCTION AND OBJECTIVE:Chronic scrotal pain is common, and has traditionally been difficult to manage. Epididymectomy is a treatment option for a subset of these men who have pain localized to ...

The spermatic cord block is a useful maneuver when performing procedures on the scrotal contents to minimize pain. It is also useful for patients complaining of testicular/epididymal pain prior to any more invasive procedures. A trial of local anesthesia can help select patients who would most benefit from a spermatic cord denervation surgery.

OBJECTIVES To assess the role of epididymectomy in the treatment of chronic postvasectomy and epididymal pain syndrome and to identify the factors that predict the outcome. METHODS A total of 38 patients, aged 20 to 70 years (mean 45), who had undergone epididymectomy for intractable intrascrotal pain, were identified retrospectively from the pathology records. The clinical notes were reviewed, and details on patient demographics, previous vasectomy, investigations, and histologic features were collected and analyzed. The outcome was assessed by routine outpatient clinic review and telephone interview. RESULTS Overall, 32% of patients reported resolution of symptoms after epididymectomy; 17 patients had undergone previous vasectomy, and this group was significantly more likely to have ongoing pain. Abnormal examination and ultrasound findings preoperatively did not correlate with a better outcome from surgery. CONCLUSIONS The results of our study have shown that epididymectomy has a limited role in the management of chronic intrascrotal pain.

To evaluate the surgical outcome in, and satisfaction with treatment of, patients undergoing epididymectomy for postvasectomy pain syndrome.A total of 49 patients were included. All participants had undergone epididymectomy for chronic epididymal pain from January 2000 to June 2009. Of the 49 patients, 4 had undergone bilateral epididymectomy, and the total number of procedures was 53: 18 in patients with postvasectomy pain syndrome (group 1, n = 16), 21 in patients with chronic epididymitis and no history of vasectomy (group 2, n = 19), and 14 in patients with an epididymal cyst and no history of vasectomy (group 3, n = 14). The preoperative and postoperative pain scale scores and surgical outcome were analyzed.For the total patient sample, the mean age was 52.91 ± 13.51 years, and the mean body mass index was 24.10 ± 3.22 kg/m(2). The mean duration of pain was 1.3 years (range 0.25-20), and the mean duration of postoperative follow-up was 4.2 years (range 0.05-10.25). The mean preoperative pain score was 6.91 ± 0.97. The mean postoperative pain scale score was 1.92 ± 1.54 (P.01). Statistically significant differences in the preoperative and postoperative pain scores were found for each group: group 1, 5.38 ± 1.47 (range 3-8); group 2, 4.10 ± 1.41 (range 2-6), and group 3, 5.21 ± 1.88 (range 2-8; P = .004). In group 1, excellent surgical outcomes and high patient satisfaction were reported for 94.5% (17 of 18) of the procedures performed.The results of our study have shown that epididymectomy is more effective in patients with a history of vasectomy than in those without.

We evaluated the long-term outcomes of patients who underwent epididymectomy for the treatment of chronic epididymal pain.All 72 patients who underwent epididymectomy at our institution between 1994 and 2007 were invited to participate in the study. Patients were mailed questionnaires covering various aspects of the treatment. Questions regarding pain were rated on a scale between 0 and 10 (0--no pain, 10--severe pain). Patients who did not return the questionnaires were followed up by telephone and the medical case notes of all respondents were reviewed. Statistical analysis was performed using the Wilcoxon signed-rank and Fisher's exact tests with p0.05 considered statistically significant.A total of 53 patients participated (74% response rate) and mean followup was 7.4 years. Of these patients 45 (84.9%) underwent epididymectomy for post-vasectomy pain and the remainder (8 of 53, 15.1%) had the procedure for various nonvasectomy reasons. There were significant improvements in pain score in the post-vasectomy (mean 7.3 preoperative to 2.4 postoperative, p0.001) and nonvasectomy (mean 7 preoperative to 2.8 postoperative, p = 0.002) groups. Of the patients in the post-vasectomy group 93.3% (42 of 45) had less or no pain postoperatively compared to 75% (6 of 8) in the nonvasectomy group. The satisfaction rate with epididymectomy was also higher in the post-vasectomy (42 of 45, 93.3%) compared to the nonvasectomy (5 of 8, 62.5%) group (p = 0.038).With high patient satisfaction and a favorable long-term outcome epididymectomy appears to be an effective treatment option particularly for post-vasectomy chronic epididymal pain.

Objectives Epididymectomy is an option for the relief of epididymal pain related to postoperative obstruction, epididymal cysts, or epididymitis. We performed 66 epididymectomies on 52 patients from 1996 to 2006 at our institution for localized epididymal pain. We evaluated the long-term symptomatic relief after epididymectomy. Methods All 52 epididymectomy patients were mailed questionnaires regarding their current pain level and satisfaction. Patients who did not return the questionnaires were interviewed by telephone for follow-up. Results Of the 52 patients, 34 returned 44 completed questionnaires (the patients with bilateral procedures were mailed a questionnaire for each side). The average age at epididymectomy was 44.2 years (range 25.0 to 67.9). The average follow-up was 45.8 months (range 4.2 to 119.3). Of the 34 procedures, 17 were left sided, 7 right sided, and 10 were bilateral; 25 had been performed for postvasectomy pain and 5 for obstruction related to hernia repair. Of the 44 cases, 31 (70%) reported no pain. Of the 13 still with pain, 8 (62%) reported less pain. Also, 90% were very satisfied or satisfied with their choice to undergo epididymectomy. Conclusions We found excellent results after epididymectomy, especially for the indication of postvasectomy pain.

Purpose: We analyzed the contemporary indications for epididymectomy, and quantified outcomes in terms of symptom resolution, complications and patient satisfaction.Materials and Methods: The indications for surgery and outcomes for 57 patients who underwent epididymectomy between 1990 and 1994 were evaluated.Results: A total of 30 patients (53 percent) underwent surgery for epididymal cysts and 27 (47 percent) for chronic epididymitis or epididymalgia. There was greater patient satisfaction among the cyst group (92 percent) compared to the epididymitis/epididymalgia group (43 percent, p less than 0.001). Furthermore, more patients in the latter group complained of subsequent problems that they considered related to the procedure.Conclusions: The outcome of epididymectomy is significantly more favorable in patients with epididymal cysts than with chronic epididymitis or intractable epididymal pain. Epididymectomy should be reserved for the former group but avoided in the latter cases unless they h...

A group of 20 surgical specimens in 18 patients with a previously unappreciated syndrome of unremitting epididymal pain and induration 5 to 7 years after vasectomy was collected during a 2-year interval. These symptoms uniformly were unresponsive to conservative measures, including empiric antibiotics. Total unilateral or bilateral epididymectomy and partial vasectomy led to complete relief of symptoms, usually within 24 hours. Pathological examination of the specimens revealed features consistent with sequelae of long-standing obstruction. Recognition of this late post-vasectomy syndrome, which represents a major complication of vasectomy, might be expected to increase as cohorts of vasectomized individuals age.