Microsurgical vasovasostomy for the treatment of intractable chronic scrotal pain after vasectomy

Arteriovenous haemangioma of the vas deferens: a case report and literature review

Arteriovenous haemangioma of the vas deferens is an extremely rare entity in clinical practice. To date, there have been no clinical or pathological cases reported in Medline, Embase or other published English literature. Herein, a 50-year-old male who presented with right scrotal pain for 4 years after vasectomy was admitted to our hospital. One painful nodule was palpable in the right scrotum on physical examination. Color Doppler ultrasound merely showed dilation of the epididymis and no additional information concerning the painful nodule in the right scrotum. Moreover, the laboratory test results were all within normal limits. Ibuprofen was administered to the patient for 2 months with a poor effect, and then spermatic cord block significantly relieved his symptoms. This patient underwent resection of the right painful nodule of the vas deferens under medical advice. Postoperative pathological examinations showed arteriovenous haemangioma of the vas deferens. There were no obvious complications after arteriovenous haemangioma excision, and the right scrotal pain was significantly relieved 1 month later. This article reminds urologists and oncologists that haemangioma can involve the vas deferens and, in addition to spermatic granuloma, might be a cause of post-vasectomy pain syndrome. Cauterization of the vas deferens might have a potential relationship with haemangioma.

Chronic scrotal pain and microsurgical spermatic cord denervation: tricks of the trade

Every practicing urologist encounters patients complaining of chronic scrotal content pain (CSCP). This condition can be equally frustrating for both patients and clinicians as there are no clear treatment guidelines, or pathways, for urologists to follow. As a result, most patients typically seek out multiple providers without improvements in their symptoms. Fortunately, microsurgical spermatic cord denervation (MSCD) is becoming an accepted, reliable and reproducible technique for definitively addressing CSCP in select patients. This manuscript reviews the background, effectiveness and current practice guidelines for scrotal pain in general, and MSCD in particular. Technical insights into how this technique can be performed both safely, and efficaciously, are provided. Finally, the manuscript presents a simple, yet detailed, easy to follow treatment algorithm to aid all urologists in the management of patients presenting with chronic pain.