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Are open-ended vasectomies less likely to cause post-vasectomy pain than closed vasectomies?

I have found https://www.vasectomy.com/question/is-open-testicular-end-vasectomy-better-11304:

This is debatable. There is slightly less chance of post vasectomy pain syndrome, but slightly greater risk of failed vasectomy. It is a discussion I often have in my office with my patients.

but no evidence is given.

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I have found two studies so far:

https://doi.org/10.1016/S0015-0282(16)44357-8:

The presence of a sperm granuloma [resulting from an open-ended vasectomy] 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.

but this study dates back from 1979 and is based on only 9 patients.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC529470/ is inconclusive but this study dates back from 2004:

Additional research would also be of interest to compare an open-ended procedure with a closed-end procedure. Several investigators have suggested that leaving the testicular end open reduces post-vasectomy pain, but no randomized controlled trials have examined this issue [1,18].

  • [1] Royal College of Obstetricians & Gynecologists . Male and Female Sterilization, Evidence-based Clinical Guideline No 4. London: RCOG Press; 2004. [Google Scholar]
  • [18] Labrecque M, Dufresne C, Barone MA, St-Hilaire K. Vasectomy surgical techniques: a systematic review. BMC Med. 2004;2:21. doi: 10.1186/1741-7015-2-21. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
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