vasectomy due to chronic uti's ?

[kiwidebs]

Has anyone ever had a vasectomy done to treat chronic uti's and epididimytus? The thoughts are that urine is back tracking into the vas defrens tubes causing pain and swelling of the testicle, and uti's. As soon as the uti us cleared with antibiotics - another one starts, perhaps from re-infection from the testicles where the bacteria may be hiding. I wote a while back about chronic uti's in my son (Tyler), always the same bacteria.......... and the hope that a CT scan may show stones, however it was clear...........the suggestion is now a vasectomy to prevent the backward flow of urine into the vas defrens. We have been referred to see another urologist to look into this. Three years is way too long to have these infections on a twice monthly basis. I hope we get some answers soon. He is 17.

Debs

[Wise Young]

kiwidebs,

Vasectomy sometimes itself causes epididymitis and chronic prostatectomy, as well as post-vasectomy pain syndrome (Source). I was suprised to hear that this is being considered as a method to stop epididymitis and therefore decided to do a literature search for any studies on the subject.

Vasectomy was apparently used in the early 1980's to stop epididymitis: (Source).
Here is a slightly more recent editorial comment about vasectomies:
http://findarticles.com/p/articles/m...33/ai_11986655

Vasectomy: principles and comments - Editorial
Journal of Family Practice, Dec, 1991 by Stanwood S. Schmidt
In this issue Alderman (1) presents a study of the complications in a series of vasectomies that were performed by a single surgeon (himself) using a uniform technique. As is common practice, most of these operations were office procedures, to which the family physician can readily relate.

Vasectomy is the most common operation in men. Many couples, anxious about controlling their fertility, will consult their family physician for advice. Certainly, it is these specialists who perform the majority of vasectomies. Although the surgical procedure is simple, the physician must study it and must be able to counsel patients properly.

It is essential that the physician realize that these are often frightened men. Every man known that the testes are particularly sensitive organs. Many men have been teased by their friends about having a vasectomy, and have been told that their voices will change, they will become fat and lazy, and so on. These notions must be rebutted by the physician, using the patient's language so that he understands and accepts the information presented. I use a booklet, (2) others use a videotape. Regardless of which educational tools are used, each patient and his wife should have a face-to-face interview with the physician who will perform the procedure. At that time questions are answered, the patient gains confidence in the physician, and the physician evaluates the patient's mental state.

I explain to the couple that the testes are a factory with two production lines, one for sperm and one for male hormones, and that the vasectomy is a roadblock that keeps new sperm from reaching the outside. I tell them that I will treat him as I would want to be treated--and that I would be the biggest coward in town! I reassure him that he will not lose his manhood and that he will continue to have all of the fun and sensation during sex that he has always had; that after we have tested and found him sterile, the only change will be that he and his partner will be spared the recurrent anxiety of a potential pregnancy.

The couple is advised to choose vasectomy only if they will accept permanent sterility, but they are also told that a vasectomy reversal often succeeds. I explain that the "sperm warehouse" must be emptied before they may discontinue other forms of birth control. Finally, they must be told that you, or an acceptable substitute, will be available if a problem arises postoperatively. Panic can result if a complication occurs and there is no physician to turn to.

Alderman has reported on the complications in a sizable series of vasectomies performed over a period long enough to uncover most complications. His list is comprehensive, but he does not tell us of the psychosexual problems that may arise postoperatively. I find that in my patients, the rate of such problems in men who have had a vasectomy is no higher than the rate in men who have not had a vasectomy. I attribute this to good pre-operative counseling. It may also be that the man who is uncertain about his sexuality would not undergo a vasectomy. Perhaps a future study by Alederman will tell us how common it is for men to consider vasectomy but not to reach the interview stage, as well as how many men discuss having a vasectomy with their physicians but proceed no further. These, too, are types of complications.

Alderman and I use different surgical techniques. His results are certainly respectable, although I shall continue to differ. He remove a segment of vas. I see no advantage in this and find that it increases the difficulties of a future reversal. I do not use ligatures on the vas (no more than I would ligate the bowel), nevertheless, his method of using many ligatures of Dexon may create long, firm scars at the cut ends. Regrettably, he does not tell us what the ligated vas looks like when it is exposed at a later vasovasostomy. In contrast, I cauterize the cut ends of tha vas so that the mucosa is destroyed and the muscularis is left viable; I then interpose the fascial sheath of the vas between the ends. (3) When a thermal ("red hot wire") cautery is used, (4) a solid plug of scar tissue results with a minimum of spermatic granuloma formation and of vasitis nodosa. Should sperm escape the vas, the fascial barrier will prevent their reaching the urethral side and perpetuating fertility.

Infection was the most common complication in Alderman's series; however, the figure of 3.8% is respectable. If I suspect an infection, I also prescribe an antibiotic, and I also use tetracycline. Alderman does not mention a condition that can be mistaken for a complication of vasectomy, funiculitis, an infection caused by refluc of infected urine into the vas. Although the vas is then infected up to the point of vasectomy, the vasectomy prevents the infection from reaching the epididymis. (5) His patient with hematuria may have been such a case.

I have never seen bacterial epididymitis after a vasectomy, and find that the above described procedure prevents this. The cases I see are due either to an engorgement of the epididymal tubules with sperm (tender thickening of the entire length of the epididymis) or to a granuloma in the cauda of the epididymis. The first always subsides spontaneously, but it may recur. The granuloma usually becomes silent, although occasionally continued pain may require removal of the epididymis. These conditions occur regardless of the vasectomy technique used. Like Alderman, I cannot explain why the "congestive epididymitis" is unilateral. I have never seen true orchitis postoperatively, although a vasectomy would not protect a man from mumps orchitis.

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In 1992, a British group studied the incidence of epididymitis in children and adolescents after initiation of clean intermittent catheterization. In 448 patient-years of experience, they found an incidence of 1 out of 10 years, or about a 10% incidence rate. In two of the patients, vasectomy and orchidectomy had to be done to prevent recurrent attacks and intractable sepsis.

[*] Thirumavalavan VS and Ransley PG (1992). Epididymitis in children and adolescents on clean intermittent catheterisation. Eur Urol 22: 53-6. The records of 119 children and adolescents on clean intermittent catheterisation (CIC) were reviewed to assess the incidence and predisposing factors, if any, of epididymo-orchitis. CIC had been performed for a total of 448 patient years with a mean of 4.5 years (range 3 months to 19 years). Of the evaluable 99 patients, 10 suffered attacks of epididymo-orchitis after commencing CIC. There was an equal incidence on both sides. Three patients had recurrent attacks. Epididymitis occurred at the rate of 1 episode for 10 patient years. Those who had neuropathic bladders and more than 2 symptomatic urinary tract infections annually had a higher incidence. Prophylactic antibiotics did not reduce the incidence but long-term specific antibiotic therapy may prevent further attacks. Vasectomy and orchidectomy had to be done in 2 patients for recurrent attacks and intractable sepsis. Hospital for Sick Children, London, UK. http://www.ncbi.nlm.nih.gov/entrez/q...t_uids=1425846

In 1984, Richter, et al., published a paper the following paper:

[*] Richter S, Embon O, Saghi N and Bechar L (1984). Vasectomy to prevent acute epididymo-orchitis after prostatic adenomectomy: still a controversy. Urol Int 39: 283-5. There has been a controversy for almost 80 years about the usefulness of vasectomy in the prevention of acute epididymo-orchitis (EO) after prostatic adenomectomy (PA). In the last few years, improved surgical equipment and new more effective antibiotics have drastically diminished the incidence of this complication. The purpose of this report is to show that because of the devastating effect of the disease, and in spite of its low incidence there is still a clear indication for vasectomy, and also that infected urine, a preoperative indwelling urethral catheter, duration of postoperative catheterization and postoperative complications do not affect the incidence of post-PA acute EO. http://www.ncbi.nlm.nih.gov/entrez/q...t_uids=6506363

There have been relatively few studies on the subject.

Wise.

[kiwidebs]

Thanks for your response and info.

Can I ask if you think that urgent care is required if the testicle is now oozing pus? (obviously from an abscess from chronic epididimytus) I know this would scare anyone new to this condition, but Tyler is currently back on Cipro (almost full time now), to treat the uti that started a couple of days ago, and its now the weekend and he noticed this testicle infection last night. This is the third time this abscess has appeared in the last 8 weeks.

Also - would a culture of this material be important for the urologists records? as he is already on cipro would it mask a result? and this morning when I checked it was not as bad as last night? I don't really want to endure 5 hours at the emergency dept to be told that cipro is the right treatment and to go home. I doubt that we will be getting in to see the new uro that we have been referred to for quite a while (could even be 2 to 6 months away)................this is common in New Zealand under the public health system.

Ta

Debs

[Wise Young]

Debs,

My bias because of my surgery training will probably show up here. I believe that such an abscess should be treated surgically. If I were your Tyler's doctor, I would schedule immediate surgery to culture, debride, and wash the entire area before starting antibiotics. There is no reason why this should not be done. It is safer, more effective, provides culture samples, and ultimately makes it more likely that the antibiotics would work.

I am so sorry that you are going through this. You should not need to sit in an emergency room to be told by some inexperienced emergency room doctor to take Cipro for a testicular abscess.

Wise.

Thanks for your response and info.

Can I ask if you think that urgent care is required if the testicle is now oozing pus? (obviously from an abscess from chronic epididimytus) I know this would scare anyone new to this condition, but Tyler is currently back on Cipro (almost full time now), to treat the uti that started a couple of days ago, and its now the weekend and he noticed this testicle infection last night. This is the third time this abscess has appeared in the last 8 weeks.

Also - would a culture of this material be important for the urologists records? as he is already on cipro would it mask a result? and this morning when I checked it was not as bad as last night? I don't really want to endure 5 hours at the emergency dept to be told that cipro is the right treatment and to go home. I doubt that we will be getting in to see the new uro that we have been referred to for quite a while (could even be 2 to 6 months away)................this is common in New Zealand under the public health system.

Ta

Debs

[kiwidebs]

I am really grateful for your super quick reply! thankyou.

Debs