Post-vasectomy pain syndrome: prevention and management utilizing current evidence and clinical pearls.

Abstract

Post-vasectomy pain syndrome (PVPS) is a chronic and potentially debilitating condition affecting a subset of men undergoing vasectomy. Despite its impact on quality of life, PVPS remains underrecognized, and management strategies are often inconsistent due to limited high-quality evidence. This review aims to synthesize current evidence on the prevention, diagnosis, and management of PVPS and to provide clinically relevant recommendations. PVPS etiology appears multifactorial, involving immunological, mechanical, and neuropathic mechanisms. Diagnosis is clinical, with adjunctive imaging and nerve blocks providing diagnostic and prognostic value. Initial management is conservative, including NSAIDs, neuropathic agents, and pelvic floor therapy. In refractory cases, microsurgical spermatic cord denervation, vasectomy reversal, or epididymectomy may be considered. Psychosocial factors are important and require multidisciplinary care. PVPS demands a nuanced, stepwise approach. Prevention through informed consent and careful surgical technique is key. Further research is needed to standardize diagnostic criteria and validate treatment pathways to optimize patient outcomes.