The presence of a sperm granuloma at the vasectomy site prevents epididymal pressure build-up, perforation, and the formation of an epididymal sperm granuloma. It thus enhances reversibility of the vasectomy and lessens the likelihood of epididymal discomfort. In two prospective vasectomy series, a sperm granuloma was intentionally allowed to form by not sealing the testicular end of the vas. The sperm granuloma resulted in no instance of orchialgia, but created a greater risk of spontaneous recanalization. This latter problem could only be solved by more careful sealing of the upper end of the vas. In a separate series of nine patients vasectomized elsewhere and specifically referred to us for chronic and persistent postvasectomy orchialgia, seven had no sperm granuloma at the vasectomy site. Pain in these cases was localized in the epididymis and was relieved by vasovasotomy. Any technique of vasectomy carries a very small risk of orchialgia, whether due to the presence of a sperm granuloma at the vasectomy site or to increased epididymal pressure.
PIP: In an Ottawa study, 410 patients consented to open-ended vasectomy, and in a St. Louis study, 23 patients underwent open-ended vasectomy, in which the abdominal end is cauterized but the lumen on the testicular side is not ligated, clipped, or cauterized. In the Ottawa series, 3% of the patients developed no sperm granuloma and 97% did develop sperm granuloma. The Concept unit was used on 148 patients with a 4% failure rate; however, the Hemoclip application was used on 262 patients with only a 0.4% failure rate. In the St. Louis series, all 23 patients developed sperm granulomas with l case of recanalization. In 9 patients referred to St. Louis for chronic and persistent postvasectomy orchialgia with pain localized in the epididymis, the pain was relieved by vasovasostomy. Evidence indicated that heat cautery was not as efficient a method of sealing the vas as the Hemoclips due to the high failure rate.