Abstract: PD05-05
Sources of Funding: none

Introduction

Post Vasectomy Pain Syndrome (PVPS) is an uncommon urological problem that remains a challenge to manage. We aim to evaluate the outcomes of patients who underwent microdenervation of the spermatic cord (MDSC) for PVPS at our institution.

Methods

A retrospective study of 161 patients who underwent MDSC by a single surgeon from March 2002 to October 2016. Pain was documented using the visual analogue scale (VAS). Spermatic cord block (SCB) was performed on all patients and success was defined as VAS ?1 for >4 hours. Patients who responded to a SBC were candidates for MDSC. All patients failed medical therapy prior to MDSC. All prior procedures for PVPS were performed elsewhere. Surgical success was defined as postoperative VAS of ?1.

Results

29 patients underwent MDSC for PVPS. Median follow up was 37 months (1st quartile 20 months, 3rd quartile 100 months). Median duration of pain prior to surgery was 57 months (1st quartile 36months, 3rd quartile 112 months). Pain was bilateral in 14 (48%), left in 11 (38%) and right in 4 (14%) patients. 9 patients (31%) had worsening pain on ejaculation. Data on SCB was available on 23 patients with success rate of 96%. Median preoperative pain on VAS score was 7 (range 2-10). Median pain following SCB on VAS score was 0 (range 0-5). Median postoperative pain on VAS score was 0 (range 0-9). Success was obtained in 71% of patients and patients with involvement of multiple structures in the scrotum (ie: testis, epididymis, spermatic cord) are more likely to have a successful surgery, p=0.016. 5 patients failed a prior epididymectomy and 3 patients failed a vaso-vasostomy for PVPS and this had no correlation with the success of MDSC, p=0.89

Conclusions

MDSC is successful and durable in 71% of our patients and is a valuable approach for PVPS especially when pain involves multiple structures in the scrotum (ie: testis, epididymis, spermatic cord). MDSC is equally as effective on patients who had previously failed a prior procedure for PVPS. All but three patients with PVPS had improvement in VAS following MDSC. No patient had a worsening VAS following MDSC. This is the largest study to date evaluating MDSC for the treatment of PVPS.

Funding

none