Post-vasectomy Pain – Neurectomy Options

Hernia Discussion Forums Hernia Discussion Post-vasectomy Pain – Neurectomy Options

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    • #10663
      m3driver
      Member

      Hello,

      I realize this is a hernia forum, but also have come to realize their is significant overlap between hernia and post-vasectomy pain sufferers in terms of symptoms and nerve involvement. I’m hoping the experts here might have some thoughts/ idea they could share, hoping they might see vasectomy pain patients occasionally in their own practices.

      I’ve had testicular and to a lesser degree abdominal pain since roughly 10 days following a vasectomy performed Jul 2012. While it has improved from near incapacitation levels, it continues as a daily struggle with pain, particularly late in the day and evening and especially with sitting. A hot bath or shower will nearly resolve the pain completely during and for a short time following, so I feel there is some neuropathic damage in the scrotum and the ability to trigger with sitting and tamp down with hot water refutes a centralization or “wind-up” theory in my non-physician mind. I’ve had lots of conservative management, including gabapentin, medrol dosepacks, NSAIDs, time (over 3 years and counting), as well as reversal, robotic denervation of the spermatic cord and Botox ablation in the spermatic cord region. None of these has been truly effective, though symptoms are not as extreme as the first 2-3 months following vasectomy. I’m currently seeing a pain mgmt (anesthesiologist) locally who has tried 3 bilateral ilioinguinal nerves blocks with limited success. Next up is perhaps the genitofemoral nerve, which seems to be frequently indicated in testicular pain cases.

      My next options seem to be nerve ablations (cryo, rf, alcohol) if responsible nerve can be identified via blockade series, inguinal orchiectomy and neurectomy of these peripheral nerves.

      My greatest appreciation for a forum such as this to allow exchange of information, ideas, etc. I feel like my issue must be neuropathic in nature since a reversal was performed and patency achieved. Many thanks in advance to the caring physicians on this site – these issues have a huge impact on quality of life for sufferers and their families, and I would be truly greatful for time taken to read this and provide any opinions, thoughts, recommendations on my unfortunate plight.

      Thank you.

    • #13209
      tokidoki
      Member

      Post-vasectomy Pain – Neurectomy Options

      I did not read your entire post but the surgery I think is called micro spermatic cord denervation if I remember correctly and I am sure I spelled it wrong.

      About 5 years ago this was fairly new and very few surgeons performed it. I think the leading expert at the time was from the Orlando area. I almost had this surgery. Be very careful, my surgeon was supposedly one of the best in the nation but only had performed about 75 at the time. When asked multiple times if he was going to perform it entirely he had a very hard time answering and finally stated his resident would do the entire surgery with him not leaving the OR. On outcomes he also had a hard time responding but stated no guarantee of pain relief and loss of testicle was another complication if I remember correctly That was the end of it. Decided I would live with the pain.

    • #13210
      drtowfigh
      Keymaster

      Post-vasectomy Pain – Neurectomy Options

      Wow. Sounds like you’ve been through a lot and had a lot done by you. I suspect you’ve already seen the national experts on this.

      My concern is that the actual symptoms have not been carefully evaluated and instead you are undergoing so many procedures to see which one works.

      Cryo, RFA, denrvation, and the like all have complications of their own, so it’s important that you have treatment targeted to your actual problem. Also, I believe nerves such as the genitofemoral are best addressed surgically, as they are small and hard to get to percutaneously.

      Where was the vasectomy done (on your body). Was it scrotal, inguinal, where was your original incision?

      Where is you pain exactly? Drawing may be helpful. Does the pain radiate?

      Who have you seen about this? Dr Paul Turek is the national leader in this field.

    • #13213
      m3driver
      Member

      Post-vasectomy Pain – Neurectomy Options

      Thanks so much Dr Towfigh for taking the time to both read my post and give me your thoughts.

      My reversal was done by Dr Sheldon Marks in Tucson, who has dedicated roughly 10% of his practice to reversals for post-vas pain mitigation with 90%+ success rates. When I fell on the wrong side of those statistics, he referred me to Dr Parekattil in Clermont FL, who performed the spermatic cord denervation and Botox ablation procedures. Prior to the denervation he performed a diagnostic spermatic cord block which seemed to help on a very short-term basis (perhaps hours).

      I have been surprised that there hasn’t been more effort to specifically diagnose the source of the pain. I have mentioned having an MRI done but the feedback I’ve gotten is that these problems do not reveal themselves with that kind of visualization. I share your concerns about both generality of approach and serial procedures but I’m not sure what to do about them.

      To your specific questions:
      -The original vas was done roughly midline-to-upper scrotum, bilaterally with two perforations and closed with sutures. There was pain and a tugging sensation on the left side during the original vasectomy procedure and numbing agent was injected a second time there. The urologist seemed genuinely surprised by my intraoperative pain. Metal clips were used on the vas ends – these were excised during reversal, which was routine vas-to-vas.

      -Pain symptoms:
      -Bilateral pain, not specific to left or right: The pain is typically accompanied by a strong tingling sensation throughout scrotum, especially with sitting. This is similar to hitting your “funny bone” and is sometimes very strong and comes in waves. This tingling has been present off and on beginning 9 days post vasectomy through present. Accompanying this is a “sitting on a golf ball” / perineal pressure sensation and burning sensation on the back side of the scrotum. I sometimes wake up with a sore lower abdominal feeling, as though doing too many crunches – this goes away quickly once I get up. Later in the day I can feel pressure on the lower abdomen and sometimes don’t feel like eating much – this feels similar to indigestion. It is also similar to what it feels like to get hit in the testicles but is lasting. The evenings are the worst, and I often just want to lie flat on my back in bed. Elevating the testicles often provides some measure of relief. A bath or shower in hot water essentially resolves all pain symptoms both during and for a short time after taking them. Pain also varies week to week, with some relatively good weeks and then an “attack” of more severe pain. After a more severe several days of pain the scrotum will feel very itchy for a day or two, which then subsides until the next episode.
      -Unilaterally, the left side has typically been the side that has hurt and whose cord was denervated. The epididymis and testicle are sore to touch, and late in the day into evening will burn at the top and back side of the testicle. In the last year or so the right testicle has also become painful to a lesser degree, and only discernible by a self-exam. These structures are all so close together than it can be difficult pin-pointing the exact location of pain. I also have some residual pain at the denervation site (left groin) that has seemingly slowly gotten better but is still significant at 10 month out from the procedure. Please see my marked-up picture attached below.

      -More recently I’ve seen a local pain management clinic / anesthesiologist. I’ve heard of Dr Turek, but was not aware he was considered an expert in addressing pain after vasectomy.

    • #13226
      drtowfigh
      Keymaster

      Post-vasectomy Pain – Neurectomy Options

      I’m going to have to do some research on this.

    • #13229
      m3driver
      Member

      Post-vasectomy Pain – Neurectomy Options

      Thank you so much Dr Towfigh, I really appreciate your time and energies on my behalf as well as the benefit of your non-urology perspective.

      Really look forward to your opinions on this.

    • #13230
      21tomlinson
      Member

      Post-vasectomy Pain – Neurectomy Options

      It’s pretty awesome that Dr. Towfigh is willing to research this. Most doctors I have met wouldn’t even put the effort in.

      Wish more doctors could be as caring as you.

    • #13241
      drtowfigh
      Keymaster

      Post-vasectomy Pain – Neurectomy Options

      Hi
      Did Dr Paul Turek contact you?
      He’s a fantastic resource for vasectomy-related pain.
      He wanted me to evaluate you for hernia and also other neuropathic pain.
      Let me know your thoughts.

    • #13242
      m3driver
      Member

      Post-vasectomy Pain – Neurectomy Options

      Hi Dr Towfigh – yes, per your recommendation I had a consult with Dr Turek earlier this week. His recommendation was to see a general surgeon (ideally you) to screen for hernia or other neuropathy, as you mention. He spoke very highly of you, and without a doubt my first choice is to see you. Since I am located across the country from you, I thought I would start with a local general surgeon and then relay his findings to you so we can create a plan from there. If you have any recommendations regarding questions I should ask or any specific items that should be checked I would greatly apppreciate your feedback. Once we have the results of that consultation, I would like to get your opinion as to whether it makes sense for me to fly out to see you. Would you be willing to do a phone consult with me after my local appointment? It is scheduled for mid-Jan.

      Thank you again for your advice and expertise, and willingness to share it. It seems some of these challenging conditions benefit from or even require multi-disciplinary care that is very difficult for a patient to coordinate. Doctors like you, Turek and others are a godsend to a patient desperate but determined to reclaim lost quality of life.

    • #12340
      drtowfigh
      Keymaster

      Post-vasectomy Pain – Neurectomy Options

      Happy to help.

      I offer a very extensive online consultation via my website http://www.beverlyhillsherniacenter.com

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