VASECTOMY COMPLICATIONS
Infection, hematoma, sperm granuloma and pain are the main complications associated with vasectomy. Of these, it is chronic pain that often poses the greatest challenges for both the doctor and patient. Quantifying and qualifying chronic post-vasectomy pain can be difficult since men often don’t always communicate their discomfort to their doctors and if they do, they often understate the extent of the discomfort. Even when patients are willing and able to communicate their pain, there exists no standardized approach used by urologists to qualify or report such pain in the medical literature. For these, and other reasons, the rates reported for chronic post-vasectomy pain often vary significantly.
 
One of the more substantial discussions of this important issue was made by Anware, McNicholas and colleagues in a paper titled; Complications of Vasectomy[1]. In this review of the available literature through Medline, the authors reported the following complication incidence rates:
                       
·         Hematoma                                            2%                   (range: 0.09%-29%)
·         Infection                                                3.4%                (range: 12% - 38%)
·         Sperm Granuloma                                                          (range: 10%-30%)
·         Late recanalization                                 0.05%               (range: 0-2%)
·         Scrotal pain                                                                   (range: 15%-52%)
·         Chronic Orchalgia affecting QOL                                      (range: 2.2%-15%) (Patients who sought treatment)
·         Trauma (150 patient study)                         4.7%                (perforated small or occult hydrocoele)
 
Hematoma rate seemed to correlate to surgical experience with those surgeons performing 1-10 vasectomies per year experiencing a hematoma rate of 4.6% while those who performed from 11-50 vasectomies per year saw a 1.6% rate. No-scalpel vasectomy has reduced hematoma level. Pain emerged as the predominant complication, although the authors note that selection bias may play a part in these results.
 
Lebreque and colleagues, in their systematic review of vasectomy techniques in 2004[2], reported hematoma rates as ranging widely between 0.3% and 18%. Infection rates were reported in this study as ranging between; 0.15% to 18%
 
A Questionnaire-based study was performed in by Choe and Kirkemo and published in the Journal of Urology[3] in 1996. Their evaluation of 182 respondants revealed the following complication rates:
 
·         Hematoma                                            12.6%
·         Superficial infection                                3.3%
·         Epididymitis                                           6.6%
·         Spermatocele                                         1.6%
·         Hydrocele                                              1.1%
·         Chronic scrotal pain                                18.7%
o    Occasional discomfort                       70.6%
o    Minor nuisance                                 17.6%
o    Negative quality of life                      11.8%
§ Pain during sex                          2.9%
§ Pain during ambulation               5.9%
§ Pain during both the above          2.9%
 
[1]Ann R Coll Surg Engl 2005; 87: 406–410
[2]BMC Medicine 2004 2:21
[3]J Urol. 1996 Apr;155(4):1284-6.

 
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