Dr. Towfigh – Neurectomy

[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.

[Unknown Member]

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

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

[Unknown Member]

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

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.

[Unknown Member]

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 Unfortunately it has been replaced by nerve damage pain!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

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?

[Unknown Member]

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

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?

[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!

[mtevere]

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