Dr. Towfigh – Neurectomy

[mtevere]

ブランド 財布 アナスイ

それはまた、私たちの国の安全のために不透明感を与えたが本当に専門的に行って、あなたのスタイルとデザインコンセプトを得るためにはもうプロのアーティストを見つける必要がないため、そして、あなたもまた、あなたの予算を伸 これらは一般的に これは巨大な足を持っていることの頭痛に苦しむ人々に朗報ですの製材巨大なトラックで今完全に横に左車線であったように車の前を過ぎて、アンドリューは、ハード左にホイールをスピン滑空,ブランド 財布 アナスイ
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trategy,楽天 財布 アナスイ.The AlternativeRightを再考するほうが良いと思い、そこにもう一方の側はそれになりますと、それは電気の自家製ソースですトップグリップハンドル、無マールゴムストリップインサートを持っており、二重の仕事上の追加 あなただけでなく、これまでに、これらのラフと厳しい経済状況の中に、あなたのビジネスは、生きていると蹴り保つためにあなたの消費者を取得と維持に向けて、あなた 堅牢なドライブについては、あなたは余裕ができるしているようにあなたのラップトップコンピュータ上の大きな面倒なドライブとしてにお金を入れた温かい、または冷たいリードのいずれかに電話をかけることは非常に困難である
このオークションの取引が付属して多くの利点の中で、実際の土地とそれに付属しているほとんど常にクリーンタイトルの低い価格です2005、彼らているように見えた到達パドマブーシャンする認識彼賢い熟考生成するをAすばらしいネイティブインディアン企業 あなたが正常にあなたが一日をオンラインで25-50リードを生成するために配置することができますマーケ 確かに、我々はそれが簡単に完成したよりも述べたと言うことができますが、場合には、あなたはそれはあなたが信じているより簡単です努力を出す
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[21tomlinson]

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.

[Chaunce1234]

Dr. Towfigh – Neurectomy

Sorry to hear you’re having trouble. The best advice I would give you is to see David Chen, MD in Los Angeles (general surgeon). He has a lot of experience with chronic groin pain, and access to some anesthesia folks who also have a lot of exxeprience. In the mean time, try some myoflex cream or aspercreme. I know it sounds a bit too simple, but some I have siuggested this for have had remarkeable results. They are also easy to get, inexpensive, and safe, as long as your not allergic to aspirin. Hope this helps!

[drtowfigh]

Dr. Towfigh – Neurectomy

Thanks for posting.

Some questions and thoughts:

– what do you mean by “stripping”? Was it a varicocelectomy? Microscopic denervation? Epididymectomy? Hydrocelectomy?
– what problem was your urologist trying to address? Be specific.
– did you undergo vasectomy?
– where is the incision for this procedure? Groin (above the groin crease)? Scrotum on top part? Scrotum on bottom part?

Where exactly do you have pain? At the groin above the crease or below the crease within the scrotum? Is the skin hypersensitive at your upper inner thigh? At the lateral edge of your scrotal skin? Does the testicle itself hurt? Any pain with activities?

Have you seen your urologist? What does he/she say?

[21tomlinson]

Dr. Towfigh – Neurectomy

Good morning Doctor, and thank you for the reply.

The procedure that was done was a spermatic cord denervation, although my urologist did not use a microscope to perform the procedure.. He claimed it was not necessary to use a microscope.

I underwent the procedure to deal with some testicular pain I had been experiencing. A little over 10 years ago when I was in my late teens, I had epididymitis due to infection. I treated the infection with antibiotics, however I always experienced some residual testicular pain with activities. My urologist told me that the cord stripping procedure would alleviate this pain, so I agreed to it. I have never had a vasectomy or any other type of groin surgery.

The incision was made low in the groin, just above the pubic tubercle. There was no incision made in the scrotum. Here is operation report, if this helps:

“”The patient was given a general anesthetic and placed in the supine position where he was prepped with Betadine and draped in sterile fashion. A transverse right inguinal incision was made just above the pubic tubercle and the right spermatic cord was identified just below the external inguinal ring. A Penrose was placed under the spermatic cord. Electrocautery was used to divide internal spermatic fascia and cremasteric muscle fibers in a circumferential fashion. Smaller spermatic veins were ligated with silk and divided. Care was taken to avoid damage to the vas deferens and vasal artery and to a moderate-sized internal spermatic vein. Scarpa’s fascia was closed with interrupted 3-0 Vicryl suture. Skin edges were reapproximated with running subcuticular 3-0 Monocryl. A total of 8 mL of 0.25% plain Marcaine was used for local anethesia. Dermabond was placed in the incision. The patient tolerated the procedure well. He was awakened from anethesia and transported to the recovery room in stable condition.”

The pain, from my perspective, seems to be in the distribution of the genital branch of the genitofemoral nerve. I do have skin hypersensitivity and burning pain on the lateral edge of the scrotal skin. I believe I have this on the upper inner thigh as well. Physical activity does increase the pain and discomfort. When I first wake up in the morning, there is not too much discomfort. But as soon as I start moving around, the pain starts and persists throughout the day. Sitting is also very uncomfortable.

I had the surgery back on April 20. When I initially began experiencing the symptoms (about two weeks after surgery), I did go back to my urologist to let him know what was going on. He said that the symptoms were just typical recovery symptoms and that I had nothing to worry about. The symptoms continued intensifying though, so I went to a different doctor (pain management physician) who diagnosed the condition as genitofemoral neuralgia. In doing my own research, my symptoms seem to correlate with this condition.

I no longer have the testicular pain that I had before the surgery. The symptoms I have now are all new and were not experienced prior to the operation.

Please let me know if I can provide additional info, Doctor, and thank you so much for taking the time to answer my questions.

[drtowfigh]

Dr. Towfigh – Neurectomy

Based on your description, you may have a genitofemoral and/or ilioinguinal nerve injury.

Did you get local anesthetic injection by your pain doctor? This should help. It’s a bit difficult to do for that nerve in particular. If your pain doc can’t do it, seek one who can.

You may also have an occult inguinal hernia. Dynamic ultrasound or MRI pelvis should help discuss this.

I can help you if you wish to drive up a couple of hours. Dr Chen is also an excellent resource, also in Los Angeles.

I don’t recommend re operation unless you have no long term improvement in your symptoms or if you have an inguinal hernia as the cause of your symptoms.

Btw, did your original preoperatice pain ever get better?

[21tomlinson]

Dr. Towfigh – Neurectomy

Thanks Doctor, I can definitely drive up.

I did have a genitofemoral nerve block done. It helped for a short period of time.

I did recently have an MRI which did not show any hernia.

The preoperative testicular pain is no longer present. Unfortunately it has been replaced by nerve damage pain!

If you were to perform a re-operation, what would you recommend? Do you think it could potentially help?

Thanks Doctor.

[drtowfigh]

Dr. Towfigh – Neurectomy

I’d have to confirm there is no hernia.

I would also submit you to repeat injections. If you had short term relief with injections, that is a good thing. In my practice, I would inject every two weeks until your pain is decreased.

If you fail that, then you may benefit from a surgical neurectomy. That can be done laparoscopically.

[21tomlinson]

Dr. Towfigh – Neurectomy

Thank you Doctor.

I went to your website and it looks there is phone number there to contact. Should I call to set up an appt.?

[drtowfigh]

Dr. Towfigh – Neurectomy

Please do or just send email via Contact Us section. Mention HerniaTalk forum.

[21tomlinson]

Dr. Towfigh – Neurectomy

Thank you Doctor.

I am encouraged to know that surgical neurectomy is an option, albeit a last option. From my research, the data seem to indicate that neurectomy is less successful when the genitofemoral nerve is the source of neuropathy. This is a bit discouraging to me since I’m certain that this nerve is the cause of problems. However, perhaps I’ve interpreted the data wrong. Do you feel that surgical neurectomy can be successful in patients in whom the genitofemoral nerve is the source of pain?

Sorry if I’m asking too many questions. I’m just trying to get a handle on things.

[drtowfigh]

Dr. Towfigh – Neurectomy

I believe the study you are referring to is based on the open neurectomy. It is much easier and more effective to perform the genitofemoral neurectomy laparoscopically due to the nature of where the nerve lays.

[21tomlinson]

Dr. Towfigh – Neurectomy

Thank you Doctor. This whole ordeal has been somewhat of a nightmare. The urologist who performed my denervation claimed that he had been doing the procedure for over 20 years and that everyone he had operated on had always gotten better. Afterwards, I found out that this wasn’t exactly true. When I developed the symptoms of nerve damage after surgery and was diagnosed by the pain doc with genitofemoral neuralgia, the urologist told me that my symptoms were brought on by anxiety.

I guess “anxiety” is a buzzword that some surgeons use when they injure someone and don’t want to acknowledge what happened.

Suffice to say, I’ve been treated pretty horribly through this whole ordeal. I kind of feel like I’ve seen the dark side of healthcare. I’ve been sold a procedure that I didn’t need, lied to, injured, then tossed aside like trash. No compassion for what this has done to my life, my family, and my career.

Sorry for the rant! Sometimes I need to get it out.

[drtowfigh]

Dr. Towfigh – Neurectomy

Your problem is curable

[21tomlinson]

Dr. Towfigh – Neurectomy

Thank you Doctor. This has been the fight of my life. Everyday is a struggle for me as a result of this neuralgia pain. I can’t even sit in spot for long because the pain overwhelms me. At times I feel like giving up, but you have given me hope. Thank you Doctor.

[21tomlinson]

Dr. Towfigh – Neurectomy

Hello Dr. Towfigh,

Hope all is well. I haven’t been up to see you yet because I am fighting a bit of a battle with my insurance company. I am under an HMO and they obviously they don’t want to cover anything outside of my network. I requested a referral to you but they want me to see one of their doctors. I will hopefully have this worked out soon.

One question I have, Dr. Towfigh: Why is it that the vast majority of doctors out there are unaware of the work that you, Dr. Chen, and others have done for the treatment of chronic groin pain? Pretty much every doctor I have been to about my problem has told me “I’m sorry, you have permanent nerve damage in your groin. There is nothing that can be done.” If I had not done my own research, I would not have even known about you and Dr. Chen, because all of the doctors I have talked to have told me that there is no cure for genitofemoral nerve injury.

Why aren’t more physicians aware that there is treatment out there?

[21tomlinson]

Dr. Towfigh – Neurectomy

Hi Doctor, me again 🙂 I had a follow-up appointment with a urologist last week (not the one who operated on me) and he told me told me that my problem is most likely due to a neuroma of the genitofemoral nerve, and that I may benefit from having this nerve removed. Obviously, having the nerve removed is a bit unsettling to me, but it seems that this is done in some other procedures, so perhaps I shouldn’t worry too much. A couple of quick questions:

– When men have an orchiectomy performed, does the genital branch of the genitofemoral nerve get cut/resected as well?

– When men have a shouldice hernia repair, does this nerve also get cut/resected?

I am just asking because men who have these procedures performed seem to do pretty well, so maybe i wouldn’t miss the nerve too much.

Sorry, I know I have a lot of questions! I know you’re busy so please take your time in answering. Thanks Doctor.

[drtowfigh]

Dr. Towfigh – Neurectomy

Wow. That’s unfortunate. Not sure why nerve damage would be brushed off as incurable. Dr Chen, I, and others have written pretty vastly about the treatment of nerve damage. However, unfortunately, there is not much cross-training and so urologists are mostly not aware of what general surgeons practice, and vice versa. So if these are urologists telling you there is nothing to do, it usually means there is nothing they can do. Other specialists can help.

As for your questions:

– orchiectomy does not typically include genital nerve resection.
– the genital nerve is not intentionally transected with any hernia repair
– if you’re having pain from that nerve, you won’t miss it too much when its resected.

[21tomlinson]

Dr. Towfigh – Neurectomy

Thanks Doctor. In doing my research regarding my problem, I was reading a bit about the Shouldice hernia repair. I know that this repair isn’t commonly practiced anymore, but in the description, it says that they routinely resect the cremaster muscle. From Master Techniques of Hernia Surgery:

“The lateral flap of the cremaster is doubly clamped halfway between the pubic spine and the deep inguinal ring, divided and each stump doubly ligated. These stumps will include the genital branch of the genitofemoral nerves and the cremasteric vessels.”

So I assume this means they do transect the nerve?

And yes, a handful of urologists told me that my problem is completely incurable. Thankfully, I found you and Dr. Chen, as well as a few others that have written on the topic. If I had listened to my Doctors, I would still be walking around thinking that I am in incurable,

[21tomlinson]

Dr. Towfigh – Neurectomy

Hi Doctor,

You are going to kill me for asking so many questions :p One other thing I wanted to mention, and I am not sure if you would be able to answer this one: Ever since the surgery in which I sustained the nerve injury, my head has felt very hot and achy on a daily basis. I don’t have a fever, but my head just feels very hot and a headache usually accompanies it. This has been every day since the surgery. I am not sure how a nerve injury in my groin would cause these types of symptoms, but it must be somehow related because this was not happening prior to surgery.

I am sort of at a loss for how to answer this one. Maybe it has something to do with the fact that the damaged nerves are sending signals to my brain and causing the headaches? I really am at a loss.

Not sure if you have any ideas on this one., but I wanted to ask just in case. Thanks Doctor.

[drtowfigh]

Dr. Towfigh – Neurectomy

We don’t know as much about the human body as we would like to. Nerve damage is an especially ambiguous part of medicine as it can act on many other parts of the body without any direct scientific or anatomical relationship. I cannot explain your headache, but I also cannot say it isn’t related to the nerve damage. We doctors just don’t know enough about these things (yet).

As for the Shouldice technique: yes, the cremasteric muscle is cut as part of the original description of the repair. The genitofemoral nerve, however, is spared.

[21tomlinson]

Dr. Towfigh – Neurectomy

Thanks Doctor. I was reading a Medscape page that included a roundtable discussion with some General Surgeons, which included Dr. Amid. I know that Dr. Amid is retired now, so the discussion was probably from a few years back. I had the impression that the genital nerve was resected as part of the Shouldice Repair from this roundtable. An excerpt from the discussion:

[i]Dr. Fitzgibbons]

Again, this is from a few years ago, so things may be different now. Thanks for the info with regard to my headaches. I know this is a tough one to figure out. My hope is that once the nerve damage was treated, the headaches will subside.

[drtowfigh]

Dr. Towfigh – Neurectomy

This is a fantastic discussion among true pioneers and experts in hernia surgery.

That said, we try not to injure or sacrifice the genital nerve with the Shouldice repair.

I hope you get treated, so that the nerve pain you have does not continue to spread to affect you with other parts of your body.

[21tomlinson]

Dr. Towfigh – Neurectomy

Hello Doctor,

Just an update. I was able to get in and see Dr. Chen at UCLA. His notes were as follows:

“GU: R testicle lower than L, absent cremasteric reflex on R, no-TTP, previous incision at R mid mons pubis with well-healed scar, with decreased sensation surrounding previous incision site.

I would recommend selective neurectomy given his mechanism and dermatomal distribution,. At that time, we can perform a vas neurolysis in the preperitoneal plane given this would have minimal morbidity and given that he has already had this done distally with incomplete efficacy.”

Dr. Chen let me know that he usually resects all 3 nerves, however in my case, this was not necessary since only the genitofemoral nerve is likely injured. He has scheduled me for a selective genitofemoral neurectomy in February.

I am glad that I finally have some light at the end of the tunnel.

[drtowfigh]

Dr. Towfigh – Neurectomy

🙂 so awesome. Very happy for you!

Send us an update once you’re healed.

You’re in good hands. I hope he knows you were referred from HerniaTalk

[21tomlinson]

Dr. Towfigh – Neurectomy

Yes, I was sure to let him know 🙂 He seemed surprised that I was able to find him.

As I mentioned earlier, I would not have known about you and Dr. Chen if I had not done my own research. All of my doctors have been telling me that there is no help for my problem. They are completely unaware of the work that you, Dr. Chen and others have done for the treatment of this devastating problem.

Hopefully there is a way to get the word out to more doctors about your work. There are probably a lot of patients out there who are suffering and being misinformed by their doctors that there is no help for them.

[21tomlinson]

Dr. Towfigh – Neurectomy

Hi Doctor, last question I promise :p I’ve been doing so much research about the genital branch of the genitofemoral nerve that this question is bugging me. When urologists perform a radical orchiectomy, they go up high up in the inguinal canal and cut the entire spermatic cord and remove the cord along with the testicle. Since the genital nerve runs in the cord, wouldn’t that nerve have to be cut since they are removing the entire spermatic cord? I don’t see how they could preserve it if the whole cord is being removed, and that nerve runs in the cord.

Thanks for humoring me on this one 🙂

[drtowfigh]

Dr. Towfigh – Neurectomy

I don’t understand the objective of this question.

Radical orchiectomy is for cancer and so all potential sources of communication with the spread of the tumor are removed. The orchiectomy is done via inguinal approach and the cremasteric muscle is transected. That usually includes the genital branch of the genitofemoral nerve. It is typically not spared.

That is different from regular orchiectomy for benign causes, in which the minimal amount of removal is performed and a scrotal incision is made, this the genital nerve is not at risk.

[21tomlinson]

Dr. Towfigh – Neurectomy

Thank you Doctor, I know it seems like a strange question but you don’t know how much your answer has helped me and I’ll explain why.

I have been nervous about the prospect of having this nerve resected because I did not know anyone personally who has had this operation performed. However, I do have a friend who had to have an inguinal orchiectomy performed for cancer. He is now back to 100% of the person he was before the orchiectomy, is very active in sports and is pain free. Because of your answer, I know that he has had this nerve transected and thus I feel much more optimistic about what my own recovery will be and confident that I will be able to get back to the person I was before I sustained this nerve injury.

I know it probably sounds weird, but your answer makes me want to hug you. Thank you so much 🙂

[jnich74]

Dr. Towfigh – Neurectomy

Hello Dr Towfigh

This topic seems to follow my issue very closely. Do you have any referals or contacts in the NY city area I can refer too? I would like to see a specialist like yourself or Dr. Chen near or around the NY City area. I have been dealing with the same situation as 21Tomlinson and don’t know where I can find a knowledgeable and trustable specialist. My Doc is Stumped adn has no answer for me.

Thank you

[drtowfigh]

Dr. Towfigh – Neurectomy

Try Dr Brian Jacob

[21tomlinson]

Dr. Towfigh – Neurectomy

My laparoscopic genitofemoral neurectomy with Dr. Chen is tomorrow morning at 11:00 AM. I don’t know how I’ve managed to suffer this much and make it this far, but it could all be over very soon.

Dr. Towfigh, thank you for this forum and for your compassion. You gave me hope that I thought was lost.

Wish me luck!

[21tomlinson]

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.

[jgens99218]

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

[21tomlinson]

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.

[otzi]

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!

[drtowfigh]

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.

[21tomlinson]

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.

[otzi]

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?

[jgens99218]

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

[drtowfigh]

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.

[drtowfigh]

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)

[jgens99218]

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

[21tomlinson]

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.

[jgens99218]

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

[21tomlinson]

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.

[21tomlinson]

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.

[drtowfigh]

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.

[drtowfigh]

Dr. Towfigh – Neurectomy

Also, it seems to me you are having way too many operations back-to-back.

Time can be a remarkable healer.

[21tomlinson]

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.

[21tomlinson]

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.

[drtowfigh]

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.

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