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Denervation with Dr. Parekattil at PUR in Clermont


#1

Hello everyone. Thought I would try to get more advice/ ideas. Original closed end vasectomy done in December 2015. I did have some minor level of pain prior to Vas after any kind of ejac/ activity. The urologist always said reason for pain was varecocele, but it’s very small. He was the same Doc that did the Vas. In fact he said that by doing Vas, I may actually feel better. Well that’s a joke! I was scheduled for Denervation with Dr. P on December 7th and just now cancelled my procedure. Original Cord Block done on November 1st and was free of pain for 3 hours. When block wore off, had more pain over last 3 weeks. Spoke with Dr. P a few days after the block and he suggested doing Varecocele with denervation. Can anyone share any experience with Dr. P with Denervation. I know there is a lot of negative results, but most are done with the traditional procedure. Any help would be appreciated. Thank you


#2

There’s several negative reviews, and/or feedback’s on this site with the specific procedure you are considering.

It’s said to be a 1% chance of making anyone worse off in the long run by the man himself based on quoted conversations, and if that’s the case, considering how many times this procedure has been done since the first one, many of them are on this site. Some were members here before they had the procedure, so it’s not like they came here just to leave negative feedback for that specific procedure, and/or surgeon.

Like all corrective procedures, it’s definitely a roll of the dice, and beins it’s a procedure that focuses on targeting nerves, when things go wrong, you get where I’m going with this.


#3

I’m guessing you mean he suggested varicocelectomy and de-nervation at the same time. I know both procedures can be done through the same incision, simultaneously, etc.

Back when I worked with the same surgeon your speaking of, I was offered the same procedures bundled together, or as separate procedures. I declined having either.

Back then there seemed to be to much pressure to have his version of de-nervation, which was a big turn off for me, and considering many things, including I just wasn’t seeing all the positive testimonials in the pain forum I was a member of back then, I declined having either. Unfortunately, some of these trends seemingly continue to this day.

To bad every man that’s had these procedures for pvp, pvps, varicocele pain, etc didn’t leave a review online for the procedures you are considering. It would be inaccurate for us to assume to much regarding statistical outcomes of the procedure/s you are considering.

I do understand how the surgeon you are considering rates outcomes, but honestly, I’d rather see a third party handle that stuff one on one with the patients themselves. And I wish that for all the pvp/s surgeons that get mentioned regularly on this site.


#4

Thanks for quick reply. So what did you end up doing? My issue is that since I had minor pain prior to vasectomy. So I guess a little different than most of folks here with no issues before the Vas.

I am starting to think that if I can make it from day to day, then I should leave it alone.

Thanks again KB


#5

I had a similar story as you pre vas, so, your not alone. In fact, there seems to be several of us on this site.

My pre-existing scrotal issue was varicocele pain related, and like you, mine is/was pretty small as well, grade 2 to be exact. Pre vas many years, my urologist said it was hard to believe it was causing me so much grief.

My varicocele pain was asymptomatic, and/or dormant prior to the vasectomy, and had been for many years. I wasn’t 100% pain free every single day over all them years gone by, but I was pain free enough that I had pretty much forgot about it, and had been that way for many years pre vas.

Once things went asymptomatic pain wise, I didn’t have to take any sort of medications over them years gone by either. I considered myself pretty much cured, and/or asymptomatic far as the pain I experienced for as long as a 9-12~ months after I took a nice tap to my groin at work back in the early 2000’s which I believe was the catalyst to my varicocele pain incident. The varicocele had probably been there for eon’s, and I never knew it. I didn’t know the terminology, etc, etc.

I’ve had two vas to vas reversals, and one varicocele embolization procedure. In my case, the reversals were of some help to me, although my first reversal recovery was pretty rough to say the least.

I’ve posted pictures of my varicocele embolization procedure on this site. I wouldn’t recommend that procedure to anyone given my outcome, what it did to me, etc, but there’s always the saying, “what doesn’t work for one, may work for another, and vice versa”. That goes for all of this stuff.

Perhaps you should, perhaps you shouldn’t. Hard to say what you should do. Only you would know. You live in your body, nobody else. Nobody has to live with the outcome of whatever you decide to do either. I’m sure it’s a difficult decision, and like the rest of us, you must make that decision for yourself.

The images taken during my varicocele embolization procedure, and some text I’ve wrote about it can be found in the thread below. You will likely find that stuff to be interesting.


#6

Would you do the varecocele repair via surgery if could redo that instead of embolization?


#7

Yes, and I’ve always said that. If I could go back in time, I would certainly have varicocelectomy, not varicocele embolization. The problem I foresee anyone considering that option is, finding someone that specializes in varicocelectomy only. I truly believe they may be a little better by experience (numbers), know more tricks, likely seen more scenario’s, abnormalities, etc than average well rounded surgeons, etc.

Generally speaking, urologists, groin surgeons, etc, specialize in multiple surgical procedures which can be a good thing, or a bad thing depending on how you look at things.

You can go read varicocele pain forums, threads, etc elsewhere, and see a lot of the same stuff we see going on here far as a bit of hit and miss regarding surgical procedures. Perhaps mostly hit, but the recoveries tend to read a lot like the reversal guys do on this site. Lots of complaints about surgical pain, etc until they finally start getting better, and eventually stop posting in many of those other places/forums.

I’m not trying to scare you, but there’s examples all over the internet to be read far as individual stories, outcomes, etc. Theres a member on this site that if recall correctly, many years ago he had several varicocelectomy procedures, and no luck. He then had a varicocele embolization procedure which he claimed finally fixed him. Unfortunately, he had a vasectomy many years later, and ended up here. No update from that member far as conservative progress in at least 7-9~ months.

Keep us posted. I’m always curious to hear updates to stories that have been posted on this site, as are many others.


#8

An interesting article for you below.


#9

And just FYI, the specific de-nervation procedure you are considering is commonly, or used to be commonly referred to as neurolysis, or targeted neurolysis. If your searching with search terms, you will want to know to search for those terms. Neurolysis of the spermatic cord, targeted neurolysis of the spermatic cord, etc.

Turns out the term neurolysis has a definition beyond anything related to de-nervation of the spermatic cord. See the link below.

Here’s another interesting article for you regarding one of the procedures you are considering. The statistics and information in the article comes out of the 2012~ era, and if you scroll down to the main article, you will see it broken down into many categories that are all worth reading in their entirety.

http://www.urologybook.com/robotic-assisted-microsurgical-targeted-denervation-of-the-spermatic-cord/

Unfortunately, I don’t know of a link to more recent data regarding the procedure you are considering. I’ve only heard repeated quotes on this forum.


#10

Figured I’d also mention that some of the ideologies found within the urologybook link I posted above are not shared as fact by everyone within the big picture of pvp, pvps, varicocele pain, testicular pain, etc.

Several of the top tier practitioners mentioned regularly on this site have completely different opinions about some of the same exact stuff, and then some.

I can’t think of much else to say that might be of any insight, or help to you. If you ever have any specific questions for me, or anyone else, please ask.

Good luck.


#11

Thank you for posting this link @RingoStar. I find the statement about illioinguinal and Genitofemoral nerves ligated before they start working on spermatic cord interesting. I believe it’s referenced as nerve fibers in video but when you review surgical technique it discusses it further. I don’t see any reference of these nerves buried in muscle or 5cm cut out in this procedure or video to avoid neuroma and nerves growing back like discussed with neurectomy procedures. It’s a question I would ask and want to know answers to if considering this option. I’m not saying one is better than the other. I know @raising4girls is also considering options and not sure if he has seen this video.

Small quote below on surgical technique:
Once Camper’s and Scarpa’s fascia are passed collateral branches of ilioinguinal and genitofemoral nerve fibers are ligated. Then the spermatic cord is brought up and a wooden tongue depressor is placed underneath for stabilization


#12

No problem @Ben.

The nerves growing back, and generally angrier is definitely something that some believe happened to them post this procedure. At least one guy on this site, or perhaps two, or more believe that’s exactly what happened to them. I’ve seen that aspect discussed since my beginnings.

I’ve also heard of pain switching sides post this procedure. We have another member on this site that has craziness in one of his legs, numbness, and then some post this procedure. I know of several at minimum that have a horror story of sorts post this procedure.

I’m certain there’s many that have something positive to report post this procedure, but I’m also certain there’s a lot we haven’t heard all the way around. No news isn’t always good news.


#13

Just to add to this and different methods I have added a link to Dr Levine in Chicago who I believe pioneered the approach. There is a video as well on his site and he discusses cutting and burying the II nerve. He also does full skeletonation. I guess as mentioned not all surgeons are the same with their methods.


#14

He certainly didn’t pioneer Dr P’s approach tho, and I’m not suggesting you meant that, just for clarification here.

Dr P pioneered his own unique approach which also involved the davinci robot. His version was always described by himself as much different than traditional de-nervation. It certainly isn’t your typical skeletonization type procedure. I can remember a guy in the far distance past comparing traditional de-nervation to the shotgun approach, and neurolysis to a sniper rifle approach.

There’s another thread on this site titled “please ask questions before de-nervation”. Type that into the search bar.


#15

Hey @VasRegret2015,

May I ask why you cancelled your de-nervation (neurolysis) surgery? Did you get cold feet? Perhaps you had a bad feeling you weren’t on the right path? What was your reasoning?

Did your urologists ever give you a reason for why they felt having a vasectomy many actually help with your varicocele pain? I’m just curious to know what the reasoning was for their opinion, and/or statement.

Thanks


#16

Hi RingoStar,

Thank you for all the information and your support. The block lasted for about 3 to 4 hours. It felt good, but then the pain got worse. I actually started having more pain a few weeks after it. This is most likely due to the needle. I started thinking that I could actually get worse after reading all the posts and getting into details of Neurolysis. I am starting to think that while for some, the procedures are very easy, for me, even small things like blocks still cause issues.

I am 39 have an 8 and 4 year old and if I am by any chance made worse after the procedure, I would feel awful that I brought this onto myself “again”. So until I see some posts or personally speak to others that are better, I did not want to move on.

If I can function from day to day and avoid certain activities, I am gonna keep on “kicking the can the down the road as they say.”


#17

Oh and I am sorry, I missed the first part of Ringo’s question. No, I never questioned the doctor’s opinion on why I would feel better with Vas. Perhaps I should have and now I certainly do. After this decision of having Vas, any small decision is done with paralysis by analysis.


#18

Yep, it had the same effect on me, and that pertains to all over my life. I really felt I had let myself down back then. It was like I wasn’t taking life seriously enough. By gut instinct I knew better than to have the vasectomy, but let some urologist talk me into it as a final decision that I’d be ok. He was well aware of what I went through with my varicocele pain incident years prior to the vas. He reviewed all my records, and still choose to not clue me on something called pvp, pvps, making things worse, etc. Blaa, it’s all water under the bridge now.

I realized many years ago that getting better is, and/or was a far better place to focus my energy on, and that dwelling on all the negative stuff would keep dragging me down, affecting my marriage, etc. It took some time (years), but I eventually got there.


#19

Interesting. The last true pvps doc I worked with told me I may be one of them guys that doesn’t respond well to surgical procedures. He recommended that I do not have any more surgical procedures because my body doesn’t seem to respond well to them.

Do I agree with him 100%? Not really, but I do agree with him for the most part~, or I agree with a lot of what he was trying to convey to me.

Ultimately, he recommended I run on time, and lots of it (years) before I considered going under the knife again.

Sure, I still think to have a varicocelectomy procedure on occasion, but I keep kicking the can down the road as you’d say, and I’ve been doing that since 2013~. On average, I’m not bad enough to consider another surgical procedure down there. I do get plenty of reminders tho.

Theres definitely some positive feedback online in regard to the procedure/s you are considering on the surgeon you are considering website, and/or Facebook page. But, considering how many of these procedures have been done over the last decade~, where are all the positive stories? And as far as that goes, why aren’t there many positive testimonials on this site, and/or elsewhere online that aren’t part of that entities website, and/or Facebook page? Those are good questions we all must all consider before rushing into anything.

Moving on, theres another guy on this site that had both of the procedures you are considering at the same time in my hay day many years ago, and it certainly didn’t help him. He moved on to have more, and more procedures after the fact, still wasn’t better, and I have no idea how he’s doing to date. It’s been many years since he posted an update on this site.

I remember 2-3~ guys that neurolysis helped a lot in the forum prior to this one (no update since), and know of one guy on this site that was more less cured~ by it as well. That guy never had a true vasectomy tho, he had vasclip, and suffered serious complications from it. Seems that guy took nearly a year to post success post neurolysis. The way I understand things, the recovery wasn’t a walk in the park by any means.


#20

Agree with you 120%. So how do you feel now? You had 2 reversals and embolization. Are you still open?