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Post-vasectomy Pain – Neurectomy Options
Thanks so much Dr Towfigh for taking the time to both read my post and give me your thoughts.
My reversal was done by Dr Sheldon Marks in Tucson, who has dedicated roughly 10% of his practice to reversals for post-vas pain mitigation with 90%+ success rates. When I fell on the wrong side of those statistics, he referred me to Dr Parekattil in Clermont FL, who performed the spermatic cord denervation and Botox ablation procedures. Prior to the denervation he performed a diagnostic spermatic cord block which seemed to help on a very short-term basis (perhaps hours).
I have been surprised that there hasn’t been more effort to specifically diagnose the source of the pain. I have mentioned having an MRI done but the feedback I’ve gotten is that these problems do not reveal themselves with that kind of visualization. I share your concerns about both generality of approach and serial procedures but I’m not sure what to do about them.
To your specific questions:
-The original vas was done roughly midline-to-upper scrotum, bilaterally with two perforations and closed with sutures. There was pain and a tugging sensation on the left side during the original vasectomy procedure and numbing agent was injected a second time there. The urologist seemed genuinely surprised by my intraoperative pain. Metal clips were used on the vas ends – these were excised during reversal, which was routine vas-to-vas.-Pain symptoms:
-Bilateral pain, not specific to left or right: The pain is typically accompanied by a strong tingling sensation throughout scrotum, especially with sitting. This is similar to hitting your “funny bone†and is sometimes very strong and comes in waves. This tingling has been present off and on beginning 9 days post vasectomy through present. Accompanying this is a “sitting on a golf ball†/ perineal pressure sensation and burning sensation on the back side of the scrotum. I sometimes wake up with a sore lower abdominal feeling, as though doing too many crunches – this goes away quickly once I get up. Later in the day I can feel pressure on the lower abdomen and sometimes don’t feel like eating much – this feels similar to indigestion. It is also similar to what it feels like to get hit in the testicles but is lasting. The evenings are the worst, and I often just want to lie flat on my back in bed. Elevating the testicles often provides some measure of relief. A bath or shower in hot water essentially resolves all pain symptoms both during and for a short time after taking them. Pain also varies week to week, with some relatively good weeks and then an “attack†of more severe pain. After a more severe several days of pain the scrotum will feel very itchy for a day or two, which then subsides until the next episode.
-Unilaterally, the left side has typically been the side that has hurt and whose cord was denervated. The epididymis and testicle are sore to touch, and late in the day into evening will burn at the top and back side of the testicle. In the last year or so the right testicle has also become painful to a lesser degree, and only discernible by a self-exam. These structures are all so close together than it can be difficult pin-pointing the exact location of pain. I also have some residual pain at the denervation site (left groin) that has seemingly slowly gotten better but is still significant at 10 month out from the procedure. Please see my marked-up picture attached below.-More recently I’ve seen a local pain management clinic / anesthesiologist. I’ve heard of Dr Turek, but was not aware he was considered an expert in addressing pain after vasectomy.