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Dr. Towfigh – Neurectomy
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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!
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Dr. Towfigh – Neurectomy
Try Dr Brian Jacob
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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
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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 🙂
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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.
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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 🙂
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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.
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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
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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.
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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.
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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.
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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.
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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.
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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,
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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. -
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.
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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?
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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.
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Dr. Towfigh – Neurectomy
Your problem is curable
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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.
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