精管結紮後疼痛症候群

精管結紮後疼痛症候群（せいかんけっさつごとうつうしょうこうぐん、Post-vasectomy pain syndrome, PVPS）とは、精管結紮術（バセクトミー）の直後または数年経過後に発生することのある、慢性の、ときに消耗性の、性器に疼痛を生じる病態[1][2][3]。 これは症候群なので、唯一の治療法は存在せず、個別患者の疼痛に対処し疼痛を軽減することが治療の中心となる[1][2][4][5]。精巣上体の疼痛が主要症状である場合、 しばしば「充血性精巣上体炎」（congestive epididymitis）と呼ばれる。

発症率

精管結紮術の4年後の患者172名を対象として電話・郵便による調査を行ったところ、回答者のうち15%が精巣に慢性の厄介な不快感を経験したほか、回答者のうち33%が精巣に何らかの慢性の不快感を経験したことが明らかになった[6]。

2017年に行われたレビュー研究は、米国において精管結紮術を受けた患者の1～2%が、術後に3か月以上の慢性の精巣の疼痛を経験することを明らかにした[7]。

2020年3月に公表された調査においては559本の査読付き論文を調査し、25個の異なるデータセットについてメタアナリシスを実施した結果、PVPSの発症率は5%（95%信頼区間: 3%～8%）であり、メスを使用する術式とメスを使用しない術式（NSV法、ノースカルペル法）の間ではほぼ同じであることが明らかになった[8]。

症状

  • 性器の持続的な疼痛
  • 運動時に生じる鼠蹊部の疼痛
  • 勃起を得る時および/または性交時の疼痛
  • 射精時の疼痛
  • 勃起機能の喪失

上記の疼痛・症状は精管結紮術後長期にわたって継続することがあり、精管結紮術を受けた男性の3人に一人に影響することがある[6][9]。PVPSの疼痛は軽度・いらいらさせる程度から、消耗性の程度に至るまで発生する（後者は少数の患者にみられる）。疼痛の程度はこれらの間に分布している。この疼痛は、精巣の背圧、精巣上体が満杯になること、慢性の炎症、線維化、精子肉芽腫症、神経絞扼のうち一つまたは複数によって生じると考えられている。疼痛は常時生じることもあれば、性交時・射精時・運動時に生じることもある。

脚注

  1. ^ a b Potts JM (2008). “Post Vasectomy Pain Syndrome”. Genitourinary Pain And Inflammation. Current Clinical Urology. Humana Press. pp. 201–209. doi:10.1007/978-1-60327-126-4_13. ISBN 978-1-58829-816-4 
  2. ^ a b “Vasectomy reversal for the post-vasectomy pain syndrome: a clinical and histological evaluation”. J. Urol. 164 (6): 1939–42. (2000). doi:10.1016/S0022-5347(05)66923-6. PMID 11061886. 
  3. ^ “Testicular Pain Following Vasectomy: A Review of Postvasectomy Pain Syndrome”. Journal of Andrology 24 (3): 293–8. (2003). doi:10.1002/j.1939-4640.2003.tb02675.x. PMID 12721203. http://www.andrologyjournal.org/cgi/content/full/24/3/293. 
  4. ^ “Early and late morbidity after vasectomy: a comparison of chronic scrotal pain at 1 and 10 years”. BJU International 93 (4): 93, 571–574. (2004). doi:10.1111/j.1464-410X.2003.04663.x. PMID 15008732. 
  5. ^ “Complications of vasectomy”. Ann R Coll Surg Engl 87 (6): 87: 406–410. (2005). doi:10.1308/003588405X71054. PMC 1964127. PMID 16263006. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1964127/. 
  6. ^ a b “Chronic testicular pain following vasectomy”. British Journal of Urology 69 (2): 188–191. (1992). doi:10.1111/j.1464-410X.1992.tb15494.x. PMID 1537032. 
  7. ^ “Post-vasectomy pain syndrome: diagnosis, management and treatment options”. Transl Androl Urol 6 (Suppl 1): S44–S47. (May 2017). doi:10.21037/tau.2017.05.33. PMC 5503923. PMID 28725617. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5503923/. 
  8. ^ Auyeung, Austin B.; Almejally, Anas; Alsaggar, Fahad; Doyle, Frank (January 2020). “Incidence of Post-Vasectomy Pain: Systematic Review and Meta-Analysis” (英語). International Journal of Environmental Research and Public Health 17 (5): 1788. doi:10.3390/ijerph17051788. PMC 7084350. PMID 32164161. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7084350/. 
  9. ^ “The incidence of post-vasectomy chronic testicular pain and the role of nerve stripping (denervation) of the spermatic cord in its management”. British Journal of Urology 79 (2): 269–270. (1997). doi:10.1046/j.1464-410x.1997.32221.x. PMID 9052481. 
腎・泌尿器系の疾患
 
疾患
糸球体病変
ネフローゼ症候群
原発性
遺伝性腎炎
尿細管機能障害
続発性腎障害
膠原病
腎循環障害
泌尿器疾患
機能障害
先天異常
感染症
尿路結石
腫瘍
性器の疾患
カテゴリ カテゴリ

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