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Dr. Towfigh – Neurectomy
Good morning Dr.,
My situation is decidedly different from most on here, but I happened to read about you in researching potential solutions to my problem so I found my way here.
First, let me start by saying that I have never had a hernia or any type of hernia surgery (I know, why am I posting on a hernia message board?) What I did have, however, was a spermatic cord stripping surgery performed by a urologist here in San Diego, in an effort to treat some idiopathic testicular pain I had been having. A couple of weeks after the surgery, I developed severe burning pain in my groin and scrotal area that has not subsided. I saw a pain management specialist for the problem, who identified the pain as being in the distribution of the genital branch of the genitofemoral nerve and has diagnosed me with genitofemoral neuralgia.
I am in pretty horrific pain and discomfort on a daily basis. I know that I likely fall outside the norm of patients that you typically treat, but I wanted to at least reach out to you and see if this is something you may be able to help with. Thanks Dr.
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51 Replies
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Dr. Towfigh – Neurectomy
I completely understand. Some pain and hernia-related complications are best treated surgically but others that are not surgical are best treated with tincture of time and doing more procedures only adds to the risk of more complications.
Follow Dr Chen’s recommendations. He is very experienced and intelligent in this realm. -
Dr. Towfigh – Neurectomy
Also Doctor, I want to say that I completely respect your advice to slow down and hold off from further surgery. I know that you are looking out for my well-being and that you don’t want to see me mess myself up further. I know as well as anyone that this is always a possibility. The only thing I want to say is that I have now lost 1 year and 4 months of my life to this dreadful condition. In the first few months following my surgical injury, I tried every conservative measure I can think of. Physical therapy, psychiatry, exercise, nerve blocks, acupuncture… you name it and I have probably tried it. But the sad reality is, the intense pain in my groin and scrotum is every bit as severe and debilitating as it was a year ago when my surgical injury first occurred. So, I just don’t realistically see it ever getting any better by giving it more time. I’ve chosen this path of aggressive surgeries because I’m fighting for my life at this point and I don’t feel that I can afford to lose any more time. I hope this makes sense, Doctor.
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Dr. Towfigh – Neurectomy
Thanks Doctor. I saw Dr. Chen. He’s a great guy and wants to figure this out. He thinks it may be my ilioinguinal nerve causing the problems. He recommended having an ilioinguinal nerve block (I havent tried this, I’ve only had the GFN blocked.) If the ilioinguinal nerve blocks works, he’ll take it out.
This whole thing is so ridiculous and frustrating. Thank you for your time.
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Dr. Towfigh – Neurectomy
Also, it seems to me you are having way too many operations back-to-back.
Time can be a remarkable healer.
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Dr. Towfigh – Neurectomy
I recommend you consult in person with Dr Paul Turek. He can help make sure you have had everything done. Also, he has great Pain Psychiatrists who have had excellent results with pain treatment using non-surgical methods.
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Dr. Towfigh – Neurectomy
Hi Doctor,
Just wanted to post with some updates. So unfortunately, the selective laparoscopic genitofemoral neurectomy did not improve my pain levels at all. I continued to have the same burning pain in the side of the scrotum that I had before surgery.
Earlier this week, I decided to undergo a radical orchiectomy. I knew it was a shot in the dark, but I thought that perhaps if I had the spermatic cord resected above where it was originally operated on, it might eliminate the pain. Again, zero improvement. I still have the burning pain.
Pretty discouraged at this point. I don’t know where to go from here. Do you have any idea why it might be that I am still in so much pain? The only thing that hasn’t been done yet is taking our the ilioinguinal and iliohypogastric nerves, but those shouldn’t have been affected by the initial surgery that injured me. So I have no idea what to do now. Let me know what you think. Thank you, Doctor.
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Dr. Towfigh – Neurectomy
JG –
My experience has not been great with nerve blocks, but I also had a pain doc who had never seen my problem before, so it is possible that he missed the involved nerve.
Spermatic cord denervation is definitely something that I never should have had done. It robbed me of my quality of life, and I have been fighting desperately ever since to get it back.
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Dr. Towfigh – Neurectomy
21
From MY experience when a nerve block is done it almost can’t help but make you feel better at least for a day from the anesthetic alone. If you have a combo anesthetic/anti-inflammatory then the anti-inflammatory will work (usually for a period of time) if the cause of pain is other than nerve pain. I have heard a lot of negative results regarding problems after spermatic cord denervation. Be very careful moving forward with further surgeries.
Good Luck
JG
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Dr. Towfigh – Neurectomy
Jgens –
I can answer that. From what Dr. Chen said, the pain should be gone immediately after surgery.
Whatever pain I have remaining should not be coming from the GF nerve. I am just not sure where it’s from.
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Dr. Towfigh – Neurectomy
Regarding the GFN Neurectomy, in usual cases will the patient know right away if the procedure was effective? What is the typical recovery period for this operation?
JG
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Dr. Towfigh – Neurectomy
JG,
In the case of isolated genitofemoral neuralgia after hernia repair, laparoscopic neurectomy is my choice of technique. For sure open would be more difficult and higher risk for additional morbidities and injury. In general, we wish to transected nerves proximal to the injury (i.e. Between the site of injury and it’s communication back to the spinal cord) -
Dr. Towfigh – Neurectomy
Otzi,
Your symptoms are highly suggestive of an inguinal hernia. The ILIOINGUINAL or genital branch of the genitofemoral nerve may be irritated by the hernia. Hence your symptoms. There is no nerve damage and also no risk for permanent injury. -
Dr. Towfigh – Neurectomy
21Tom
Did Dr Chen tell you the expected recovery time for the Neurectomy? Can you describe what you feel like at this early stage in your recovery, areas of Pain/Numbness/Burning Etc.? In my previous post I stated that I thought you should wait from here a good amount of time to see how you heal. I am concerned if you move to quickly and possibly complicate matters. I hope you feel better soon.
Dr. Towfigh – Would this patient have been better off with an Open GFN Neurectomy? Do the benefits of Neurectomy present immediately or is early stage pain/burning a sign of failure?
Thank you
JG
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Dr. Towfigh – Neurectomy
Dr Towfigh,
Thank you for your insight, this is very interesting!
I have no prior surgery or known injuries to the groin, just pain and different unpleasant feelings along the same nerve pathways from near the hip bone down into the testicle. Could a very small occult hernia cause nerve impingement or nerve damage if it went untreated?
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Dr. Towfigh – Neurectomy
Hey Otzi,
Dr. Chen did check for hernia when he operated on me last week, but did not find anything. An ilioinguinal nerve block may be a good next step. The problem in my experience with nerve blocks is that they do not last long, and my pain is not necessarily always present at the time of the block, so it’s difficult for me to tell if they worked or not.
My cord stripping procedure was done at the level of the pubic tubercle, so the ilioinguinal nerve should not have been affected, but I guess it’s possible. I have no clue what could be causing the pain still. It’s definitely very frustrating.
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Dr. Towfigh – Neurectomy
Otzi:
Thanks for your great posts.
A quick comment that may be relevant to you:
Groin pain is usually not from nerve damage unless there was a direct trauma or an operation that could potentially cause nerve damage.
Isolated testicular pain has a lot of potential causes, but once again, nerve damage is not the primary cause unless the nerve has actually been damaged.
My point is this: most patients with groin pain, especially radiating to the testicle, have a hernia.
The Puhr clinic in Florida is an excellence source for treatment of testicular pain due to an injury or prior surgery. However, in my experience, since they are urologists only, they may miss patients that have occult hernias.
In my experience, radiating pain is an occult inguinal hernia unless proven otherwise and I strongly recommend against fiddling with any nerves. -
Dr. Towfigh – Neurectomy
@21tomlinson
Sorry you are going through this. I’m a fellow patient with groin pain who has done a fair amount of studying and reading, so take my advice with a grain of salt, but… don’t give up! And please keep us all updated on your progress! Does anything feel any different now that you are a few days out? Any better or worse? Are you taking tylenol or advil or anything for pain and does it work?
Perhaps you have pain signals in the ilioinguinal nerve still? Maybe try a nerve block in that remaining nerve? I could be wrong but based on my own research it looks like the ilioinguinal (and genitofemoral) nerve is alongside the spermatic cord, so I could think it possible to damage in a cord stripping procedure.
For what it’s worth, I have had chronic testicle / cord and groin pain and was also looking into the denervation procedure at a place in Florida after being initially written off by doctors as having some idiopathic groin pain, but it turns out I may actually have a very small hernia in the area, they just aren’t sure if it would cause the pain. It may not apply to you, but perhaps try requesting a Dynamic Ultrasound with straining, it could turn up something?
Good luck, stay positive, and keep us updated!
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Dr. Towfigh – Neurectomy
Thanks jgens, will definitely keep you updated. This is a tough puzzle for me to figure out. Dr. Chen resected the genital and femoral branches of the GF nerve, so I am stumped as to what the remaining source of pain could be.
Perhaps ilioinguinal and iliohypogastric nerves need to come out as well, but it doesn’t seem that those nerves should have been damaged by my original surgery.
So, it continues to be a puzzle. Hopefully I will eventually figure out what the answer is.
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Dr. Towfigh – Neurectomy
21Tomlinson
Please keep us informed as to your progress from the GF Neurectomy. I along with others a very interested in the long term outcome of this procedure. I wish you luck and would advise to wait as long as you can before moving to quickly into your next surgery.
JG
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Dr. Towfigh – Neurectomy
So I had my laparoscopic genitofemoral neurectomy in addition to vas neurolysis by Dr. Chen on Thursday, and am currently in the recovery process.
Unfortunately, I am still experiencing intense burning in the scrotal region. I don’t think it’s anything that Dr. Chen did wrong, I think perhaps there are just other things responsible for the pain. I thought for sure this was the answer, but the problem seems to be persisting.
I’m going to take a few more weeks to recover, but if things don’t improve, I’m thinking I’ll try removal of the testicle. Perhaps there is some nociceptive pain coming from there that the GF removal and vas neurolysis didn’t take care of.
If that doesn’t work, I suppose the last option will be removal of the ilioinguinal and iliohypogastric nerves. I don’t think that these nerves would be causing pain, because my original surgery was down at the pubic tubercle level and these nerves shouldn’t have been affected. Dr. Chen agreed with this and felt that the GF nerve was the only one affected. But this would really be my last option before having to accept that I will never have my life back again.
So, feeling discouraged but still fighting. I can’t seem to figure this darn thing out.
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