Epididymectomy for acute and chronic disease

Long-term outcome of epididymectomy for the management of chronic epididymal pain

PURPOSE

We evaluated the long-term outcomes of patients who underwent epididymectomy for the treatment of chronic epididymal pain.

MATERIALS AND METHODS

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 p <0.05 considered statistically significant.

RESULTS

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, p <0.001) 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).

CONCLUSIONS

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.

Long-term follow-up after epididymectomy for 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.

Epididymectomy in the management of intrascrotal disease: a critical reappraisal

OBJECTIVE

To assess the outcome of epididymectomy as a method of treating epididymal pathology.

PATIENTS AND METHODS

Forty-one patients who underwent epididymectomy between 1990 and 1995 were analysed retrospectively; their clinical records were reviewed and their satisfaction with the outcome and relief of symptoms assessed using a questionnaire and/or telephone interview.

RESULTS

Twenty-nine patients with pain were subdivided into three categories depending on the indication for epididymectomy, i.e. post-vasectomy epididymal engorgement (eight patients), complex cystic disease (11) or 'chronic epididymitis' (10). The outcome was satisfactory in 27 of the 29 patients. The best results were obtained in the group who underwent epididymectomy after vasectomy, where seven of eight improved after the procedure. Those with chronic epididymitis had the least favourable outcome, with only seven reporting any improvement in symptoms.

CONCLUSIONS

Epididymectomy has a valuable role in the management of epididymal pathology in appropriately selected patients.

Cutaneous vasostomy: technique for treatment of chronic and recurrent epididymitis

We describe a method for treatment of patients with chronic and recurrent epididymitis. Six of 7 patients (86%) treated with this procedure between 1977 and 1980 have had no recurrent episodes of epididymitis to date. We discuss the comparative benefits of this procedure as related to other surgical treatments for acute, chronic, and recurrent epididymitis.

The surgical management of acute bacterial epididymitis with emphasis on epididymotomy

During the course of acute bacterial epididymitis of nonvenereal origin, severe epididymal inflammation and edema can produce compression of adjacent branches of the spermatic vessels, which can compromise the testicular vascular system. Scrotal fixation over the involved testicle heralds this event and indicates actual or impending epididymal suppuration. At this crucial moment either surgical decompression of the epididymis or epididymectomy is indicated to prevent ischemia of the testis and subsequent development of gangrenous epididymo-orchitis with testicular slough. Between 1956 and 1980, 14 epididymotomies were done, which resulted in salvage of 12 testicles (86 per cent). During the same period 10 patients with acute epididymitis had progression of the disease to gangrenous epididymo-orchitis, which necessitated orchiectomy. Epididymotomy can prevent progression of acute epididymitis to gangrenous epididymo-orchitis in many instances and is believed to have a role in the management of this troublesome affliction.