Tenderness of the Testicles

Q:  In the fall of 1994 I had a vasectomy performed in a urologist's office. The left side of the procedure was performed without a problem, but after the vas deferens was cut on the right side, the portion connected to the testicle slipped away and could not be recovered with the forceps after numerous attempts, and that end was not cauterized. The portion of the vas deferens leading to the prostate was cauterized, however, so there was no question of sterility.

My problem, almost a year and half after the procedure, is a continuing tenderness in my testicles. I know that sperm can be an irritant, and I was wondering whether a continuing flow of sperm from the uncauterized end of the vas deferens could be the cause of the testicular tenderness. If so, is there anything that could be done to address the problem? If not, what are the other possible causes of the tenderness in my testicles? I would greatly appreciate a response in your column.

A:  Sometimes even if both ends of the vas deferens (the tiny tube that carries sperm from the testicle to the penis) are tied and cauterized, sperm manage to leak out. Sperm are usually absorbed back into the tissue, but can form into a clump called a granuloma. In up to 3% of vasectomies, sperm granulomas can be found which could possibly result in some obstruction of ducts and pressure build-up. If you feel a pea-sized knot in your testicle that is very tender and sensitive, it may indicate a granuloma that needs to be removed.

I spoke with Dr. Frank Begun, a urology professor who performs many vasectomies, and he also wondered if you could have a chronic, low-grade epididymitis, which is not uncommon after vasectomy. Epidymitis is an inflammation of the epididymis, the little comma-shaped pouch that sits on top of the testicle and opens into the vas deferens. Whatever the case, a year and a half is a long time to have sore testicles. I would recommend that you be evaluated soon by the urologist who did the vasectomy.

"Dear Doctor" is a compilation of patient questions answered by doctors from the Medical College of Wisconsin.