Just walked out of vas urologist appointment (second visit after the vas). Going to basically document what he said for my own sake (and in case anyone else is interested).
First of all, he was extremely concerned and actually apologetic. Not dismissive at all, so that was nice. He remembered me from three months ago, and knew what my history was.
Examined me and said everything felt normal: No epididymis swelling, no granulomas that he could feel. Squeezed a bunch of things (none of them hurt much), asked if I felt a bunch of different things, etc. Seemed pretty sure it was not testicular/epididymal pain specifically. I told him my pain was mostly around the vas sites and especially the left.
I also mentioned my thigh pain and tingling and he was pretty adamant that if it was nerve pain, it wasn't coming from the nerves in my scrotum. Thought it could be from tensing or muscle tightness (which is kind of what I thought too). Told me a story about a guy that had persistent groin pain that turned out to be a muscle tear in his groin. Also heavily implied that anxiety and fixating on it was making it worse. He didn't go so far as to say it was all in my head, but I bet he was thinking it.
Told me what the plan was. We are doing an ultrasound next week, followed by an MRI if needed (not sure what this would show). If that doesn't show anything, we'll do a cord block, and if that doesn't work we'll talk surgical options.
Also, the urologist will be in the room for my ultrasound so he can direct the tech to his satisfaction. Thought that was interesting.
So I guess I don't really have any new info, but I at least know there's no abnormal findings.