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Post vasectomy complications
I was hoping Dr. Towfigh might be able to answer some questions for me. I had a vasectomy April 2014 that resulted in a bilateral huge hematoma. On day 4 I developed left lateral femoral cutaneous nerve numbness. On day 5 I developed electrical shooting pain from left ischium that radiated to back of scrotum. The entire last 2 yrs I have had constant testicular pain and swelling of testicles. Week 6 I developed numbness entire cauda equina distribution and within 2 weeks numbness entire legs to feet bilateral. Originally blocks of GF IH and II would alleviate the pain. I had a reversal oct 2014 and was told I had massive scar tissue. I saw a pudendal specialist and was told I did not have pudendal neuralgia. I had a spermatic cord denervation on right which stopped pain and numbness for 14 days. I then had cryoablation on right spermatic cord which caused atrophy of muscle above pubic bone. Since the. I have had Botox and stem cell injections. I am still getting worse I now go numb from ribs down to feet and on and off. I have atrophy of both hips and legs as well as pelvic floor and pelvis is now unstable from muscle loss. EMG of legs is normal. I cannot stand up straight, I am bent over at a 45 degree angle due to constant pain. I am seeing the head of autonomic dept at Cleveland clinic and his preliminary diagnosis was polyneuropathy due to autoimmune but all of his lab testing was negative. I have also torn both hip labrums in the last year. Blocks no longer work and my lower back pops now from muscle weakness and when it does my legs to numb and I get shooting pain into testicles. I have had MRIs of skull and entire spine and all are negative. I have had every lab test known to man and all are negative. The only positive tests I ever had were the blocks relieving pain and numbness for the first year. Obviously it was nerve damage from the original vas and have been told by one neurologist possibly the hematoma spread to pelvic floor and caused damage. Is there any chance removal of nerves higher up could help? Why would testicles continue to swell up. I also now have sperm granuloma from reversal failing and it is very painful to the touch also. I have had a constant bright red scrotum since the day after the vas, after blocks it would return to normal for a few days.
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9 Replies
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Post vasectomy complications
For sure lap neurectomy is more likely to cause atrophy than open.
The FDA just approved a nerve stimulator best used for those with groin pain. Dr Tim Davis was among the Pain specialists involved in evaluating this. He’s in Santa Monica, CA. I’ll ask him for his input.
I agree neurectomy probably not in your best interest right now.
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Post vasectomy complications
Another friend that is a pain specialist/anaesthesiologist is advising a spinal cord stimulator be placed around T6 to control pain he also agreed with neuro and said it’s not CRPS.. I’ve actually had 3 neurologists tell me it is not CRPS and 2 pain specialists. I did have 1 neurologist say it was CRPS but he was not a very nice or thorough doc and was pushing me out the door as fast as possible. He also said exercise 30 min a day and it will burn itself out in 5 years! He does not believe in neurectomies and said they usually cause more problems, but I asked him how sticking wires in my epidural space is less invasive or less risky and he didn’t have an answer. I have tried every form of gabapentin, amytryptiline, narco nucynta, custom pain creams, lidocaine to the spermatic cord gives about 30 min of relief and pressure to spermatic cord triggers the numbness throughout my legs and abdomen
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Post vasectomy complications
One of my good friends is a pain specialist he has tried everything and is not sure what to do next. We’ve done multiple blocks I’ve done more pt pelvic and regular and exercises daily since the original procedure and I’m still getting atrophy even though EMG shows no motor damage. I’ve now torn both hip labrums. The pain specialist believes it has caused some sort of mechanio or proprioceptive problem which is causing the muscle loss. I’ve seen him since week 6 and he is baffled.. The head of autonomic neurology at Cleveland clinic said absolutely 100 percent he does not believe it is CRPS and I asked him specifically. If anything my parasympathetic system is wound up and the sympathetic is down. He also believes this is causing low muscle tone. Just finished all the autonomic tests will have some answers in a week. The major weakness is psoas muscles and quads are weak and becoming contractures. which correlate with the spinal levels of the damaged nerves and I can no longer extend lower back and gave had a reversal of curve in my mechanical background my body has done everything to prevent me from putting a stretch on the nerves. Interestingly after all blocks to IG II and gf for a day I can extend back a little and extend hips again so there has to be some association. I’ve also talked to a few guys with vas nerve damage that are also developing hip socket problems. Thanks for asking though. If I were to have neurectomy would open or laparoscopic be less invasive and is there a chance of abdominal atrophy w either?
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Post vasectomy complications
I ran your situation by a renowned specialist in vasectomy/reversal/testicular pain as well as by my favorite pain management specialist.
First, I don’t understand anatomically how you can get a pelvic hematoma from a scrotal procedure. But, if you did get a pelvic retroperitoneal hematoma of significance, that can irritate all the nerves in that space, including the pudendal nerve, etc. I agree with Dr. Earle’s assessment.
That said, your symptoms are persistent, progressing, and are no longer localized. Have you considered the chance of CRPS (complex regional pain syndrome)? If that is indeed what you have, no local procedure may improve it and in fact further surgery may exacerbate it.
Do you have a good pain management specialist who can or who has treated you for this?
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Post vasectomy complications
Dr Earle thanks for replying I’m not worried about local surgeons I have spent 80k plus of my own $$ trying to find a solution so whomever would be best id be willing to travel. I live in indiana and all my previous surgeries were in Florida. The testicular specialist calls me next wk w update he’s looking at laparoscopic neurextomy of IH and GF he won’t touch II has had bad results w it. I’m also contemplating removal of testicles since they constantly swell. Would it be better to have open neurectomy or laparoscopic I want to be as careful as possible. Mg newest symptom is I can feel burning of the nerves throughout abdomen from inguinal ring to chest and when they burn I get a hotspot at around t12-L2 region in back. Any help would be appreciated
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Post vasectomy complications
acschiropractic – I’m sorry you’re going through this – it sounds awful. Something is definitely wrong, and it is unknown to medical doctors at this point. Logically, scarring from the hematoma can contract, and potentially pull on nerves causing them to send signals to the brain that are interpreted as pain. This however is speculative at best. It could be related to an unknown viral infection that has caused the abnormal response to the hematoma. That more systemic perspective could explain the symptoms from higher up, but gain, this is speculative. Unmasking an existing, but latent autoimmune disorder is another possibility as you mentioned. Medications are also a possibility, but less likely. Since the nerve blocks of the peripheral nerves you mentioned (GN, LFCN, IH, II) helped, you could consider transecting some or all of them, but the abnormal reaction you have already demonstrated raises the concern that the response to neurectomy would be highly unpredictable. I would ask your post-vasectomy complication doctor about this possibility, and whether or not he knows anyone that does these frequently in your area. Hope this helps!
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Post vasectomy complications
original vasectomy was bilateral approximately 2 inches below inguinal ring on spermatic cord. I don’t see how this could be a coincidence of the LFCN and other nerves considering it began within 3-4 days postop and I had done nothing but lay in bed.
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Post vasectomy complications
Thank you Dr. Towfigh for looking into this. Yes it is very complex and I cannot believe the changes that have happened in my body. I did not do any procedures for 6 months after the vasectomy to see what would happen and I started with the reversal just so they could see what was occurring. By the time I began 6 months later I had chronic bilateral testicle pain and numbness from basically the waist down to the feet bilateral to the calves at that time. Immediately after the surgery I did absolutely nothing but lay in bed for the first 6 days due to the hematoma with ice. the LFCN nerve went numb while I was lying flat on my back in bed and the pudendal symptoms began upon trying to get up out of bed. I have had all of my procedures done by Dr. Parakattil at the PUR clinic in florida who specializes in testicular pain and vasectomy complications. He has had other patients who developed the leg numbness and said it is from nerve crosstalk. The LFCN comes off the same nerve root as the genitofemoral, ilioinguinal and iliohypogastric so I can see the connection, but it doesn’t explain the pudendal type symptoms. I also had one doctor who believes I have deafferentation of the pudendal nerve from the hematoma due to a compression palsy. If I sleep without a pillow between my legs when I wake up my testicles swell to twice their normal size so there is something obviously triggering it. Like I said I did nothing but 2 sets of blocks for the first 6 months that relieved the pain and numbness before doing anything surgically so I don’t believe that the procedures done after the vasectomy contributed to my problems except maybe the cryoablation because I noticed atrophy over the right pubic bone about 2 months post op and after the procedure which was done on the spermatic cord I noticed bruising above my pubic bone. The original vasectomy was performed bilateral in the scrotum. During the procedure with only a local anaesthetic I did feel sharp pain and he had to renumb the area. The reversal was done midline anterior in scrotum and the spermatic cord denervation was performed at the ring. Any help is appreciated.
Thanks Dr. McVey -
Post vasectomy complications
Wow. This is truly complex.
I do not see, from an anatomic standpoint, how the vasectomy itself could cause lateral femorcutaneous nerve damage. Those two areas are very far apart. Is it possible that you had genital branch of genitofemoral nerve damage at the time of vasectomy? Where on your body was it performed: the scrotal base or near the groin crease?
It is possible that if the vasectomy procedure was performed at the groin crease and you had a lot of bleeding, that the pelvic nerves were irritated by the bleeding. That may take weeks to months to recover, but again, there should be no permanent damage to nerves due to the blood. Your body takes care of dissolving the clots on its own. The most you would have would be fibrous scar tissue in the area, and that scar is remodeled and softened with time, too.
Your symptoms may either be completely unrelated or a result of too much treatment too early in your course.
So I am stumped. Let me run this by my colleagues who specialize in some of these problems and get back to you on that.
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