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Denervation with Dr. Parekattil at PUR in Clermont


#21

I took medications such as tramadol, Tylenol, and occasional celebrex nearly everyday for many years post embolization, which was my final surgery. Like many, I choose medications, and other conservative measures such as stretching, staying active, etc over the alternative which was more unpredictable surgery.

Compared to may men I know, I am doing quite well, but things certainly aren’t perfect. I do get a lot of pain free time, pain free~ days, weeks, etc, or at least for the most part. My main trigger is ejaculating, especially if I start doing it to often.

I don’t take much medications anymore, but still keep stuff around for them moments. Simple stuff like Tylenol will generally get me through any rough patches.

My first reversal helped me some, although the recovery was pretty rough, and it was basically a dud fertility wise. I had my second (a redo reversal) a year~ after my first reversal, the recovery was night and day different than my first (better), and it was a major success fertility wise. Unfortunately, it failed around the 2~ year mark.

I didn’t get way worse when the redo failed either. Honestly, I’d say the blood congestion varicocele stuff was overriding the spermatic congestion stuff at that point. I still believe I suffer from both conditions, but varicocele/nerve is at the top of the list (my educated opinion).

Ultimately, I wish I would’ve waited things out for at least 12-18+ months before moving forward with the varicocele embolization procedure which I had 6~months post redo reversal.

In all honesty, and obviously, I wish I never had the embolization procedure.

Moving forward again…

I basically let money dictate my decision to move forward with the embolization so swiftly. I’d meet my insurance deductible for the year, and if I had it done by years end, the cost was next to nothing. Ultimately, I still paid for it, except I paid with my life.

I had a handful of respected doctors, urologists, etc, advising me at that point in my life. All but one figured I’d be ok post embolization. That one urologist that said nay turned out to be correct. His concern regarding varicocele embolization was vascular congestion, and I’d say he was definitely right.

On a side note, I’m more of a believer in the ideology that the benefits of a full clean up reversal that includes fertility isn’t usually the fertility aspect. I’m more of a believer in the full clean up aspect helping the majority~ vs the fertility aspect. Once again, just my educated opinion, and not to be confused with absolute fact.


#22

Have you considered reversal as opposed to SCD?


#23

Because I had pain prior to Vasectomy and a varecocele, the urologist does not think reversal would help alleviate all pain. I am also seeing that for most reversals fails/ scars up and back to square one. I could be wrong on this too.


#24

Well, I had my reversal for pain in 2006 and just shot 142MM sperm count on SA last week. I could be an outlier, I know. And, given your pain pre-vas, I agree with your caution.


#25

I’m not encouraging you to have a reversal, more like adding a your thought process. I too tend to agree that your issues are likely related to your pre-existing varicocele pain condition, but there could be more to it than that.

I wouldn’t put all your stock in the input of one urologist, pvps doc, etc either. Speaking with several of them may prove to be beneficial.

If you go by data that’s out there from many of the top tier pvps reversal surgeons world wide, they will tell you that reversals for pvps certainly aren’t all about patency, and in many cases are likely more about the clean up of scar tissue, perhaps nerve entrapment, among other ideologies, other things, etc.

So, what I’m getting at is that guys that end up scarred closed don’t necessarily end up back at square one by any means. That’s definitely flawed thinking.

What I’m saying isn’t new news by any means. Some top tier pvps reversal surgeons were quite aware of what I’m saying back in my early days (2010~).


#26

Like all versions of de-nervation, reversal also carries a slight risk of making some men worse, and/or doing nothing for them at all.

It’s probably fair to say that varicocelectomy carries the same risks, and/or probabilities, but I’m not certain of the statistics.


#27

In reading more about denervation and the fact the II and GF or ligated in the inguinal area at incision site it would seem this is similar to neurectomy but neurectomy is done much higher and the nerves are buried in muscle. I’m trying to understand if most nerve pain is from these two nerves and they are ligated then why do you also denervate the spermatic cord? In theory the pain signals should not go beyond II and GF in most cases once ligated. So basically if you have denervation then you have a process similar to neurectomy but lower in groin. Maybe I’m overthinking this whole thing and not fully understanding the procedure.


#28

I think @Ben is making a good point. It’s getting really confusing with all the medical terms if they are not properly defined and/or not properly understood by people reading the post. I think there are many probably mistaking terms and/or procedures. I for sure would appreciate if someone could wrap up in simple plain English what the terms “neurectomy” (https://en.wikipedia.org/wiki/Neurectomy), “neurolysis” (https://en.wikipedia.org/wiki/Neurolysis), “MSCD (microscopical cord denervation)” or “Microdenervation of the spermatic cord” (https://www.ncbi.nlm.nih.gov/pubmed/29352521) mean in the context of treating PVPS.

For me, it seems that if this procedure is done at the spermatic cord, i.e. somewhere close the original vasectomy, chances are pretty high, based on several posts here on the forum with bad outcomes, that nerves re-connect after some time, and pain levels increase.

For me, it appears that doing the denervation / neurectomy (for me it means the same, but please correct if I am wrong) higher up in the inguinal canal, where the nerves are buried in muscles, poses less risk of nerves re-connecting.

I think that urologists should not do this type of surgery at the spermatic cord. I think men could be better of with a neurosurgeon / plastic surgeon, who does this type of surgery in other areas, performing it in the inguinal canal or even higher.

Just to emphasize: I am a layman and this is my own thoughts about it.


#29

How are you feeling now?


#30

Had a pretty good week but am feeling a bit sore today. Starting to think I had an infection and the pain is returning since I’m done with the doxycycline. I think I’m going to throw a big Hail Mary pass and shoot for a month of a strong antibiotic before succumbing to surgery.


#31

And the surgery you’re considering would be what procedure?


#32

Consider spermatic cord denervation (despite bad reviews on this forum) and GF neurectomy.


#33

Who would you have do it?


#34

I guess the point I am trying to make and others have made is if you are looking at denervation you may also want to look at neurectomy because in both procedures the II and GF is ligated but with neurectomy it’s done higher and the end closer to spine is buried in muscle to avoid neuroma or pain if a neuroma forms. 5 cm is cut to avoid the nerve regenerating back together. In SCD depending on the dr it doesn’t appear they bury the nerves after the ligate them except for Dr Levine version. I would ask about how the nerves are handled if considering denervation. Both procedures have pros and cons.


#35

Hi @Ben, can you elaborate on the pros and cons of both procedures?

For me it sounds like the neurectomy is kind of safer, if it’s done higher up, than the SCD.
For me, the main risk appears to be reconnection of nerves after some time, causing more pain than before.
I don’t understand anything about any of these procedures in detail, but that’s my 2cents.


#36

Do you know the exact difference in these 2 procedures?
I think I might be a candidate for either one sometime down the road because I am connived I have mostly nerve pain caused at the orig vas site, where high res US showed lots of scarring.
For me, it appears as if a neurectomy, done higher up in the groin, should be a “safer” option than the SCD because of less risk of nerves re-connecting. What’s your view on that?
What are the differences in the ways these 2 surgeries are done? Pros and cons?


#37

I THINK I know the difference but it’s only as has been conveyed to me in layman’s terms by doctors and by other forum members. Here’s what I believe to be true today (subject to further verification):

SCD is less invasive. The incision is made low in the groin and the cord is pulled up so the nerve branches and other items being cut (normally located below the inguinal ring or in the scrotum) can be accessed through the incision. Branches of nerves are severed. In addition, I believe veins are cut, and a section of the outside covering of the vas is shaved off (or, optionally, the vas is cut entirely thus giving a man a vasectomy or reversing a reversal).

To me, SCD is a bit of a shotgun, spray-and-pray approach. They try to hit everything inside the scrotum that might be sending pain signals. I actually like that approach if the specific pain generator can’t be identified. I’m pretty sure SCD doesn’t help if the pain source is the pudendal nerve. I’m not sure if the other nerves (superior, middle, inferior) that come from S2, S3, S4. I worry about this for me.

Neurectomy is done above the inguinal ring before the GF and/or II/IH branch inside the scrotum. As a result, the analogy is made that you’re taking down a tree by the trunk instead of by the branches. To me, this seems like more of a targeted, rifle than shotgun approach. And, yes, both peripheral nerve surgeons I’ve consulted with have discussed that burying the nerve in muscle helps prevent reconnection and neuromas.

I’ve gotten immediate, short-term pain relief from cord blocks, but I’ve also gotten immediate, short-term pain relief from a GF block. Nothing from the II/IH block. So, for this reason, I THINK both COULD work for me, but the GF seems more targeted and definitive. At the same time, I like that SCD takes other variables out of the equation at the same time.

My situation is a bit more complicated in that there’s speculation I have a small inguinal hernia. I’m going for a dynamic ultrasound in 4 weeks for this. If I have a hernia, the guy who would do a GF neurectomy can also repair the hernia, so I’d probably head down that path. The urologists who do SCD cannot repair the hernia, so that’d potentially mean another surgery. No thanks.

Again, what I’m stating above is my understanding, not medical fact, and I’m open to corrections from anyone.


#38

Much appreciated! It kind of confirms what I was thinking, but you’ve done much more research than I have at this point, and my understanding is still pretty much beginner’s level. I wish you all the best with whatever option you choose for yourself, I really do.


#39

I think that’s a fair statement myself. I’d say pretty much every single person on this forum has their own bias opinion’s on pretty much anything, and everything, including all versions of de-nervation.

I know of guys that have claimed victory with pretty much every single known surgical corrective procedure out there. If I/we know of these stories, there’s certainly more to be heard. I suppose the same could be said in regard to bad stories too. We only know what we know based on however we learned what we know.

A good example of how we are all bias to some extent is, very very few, if any of us would recommend a vasectomy to anyone, yet the majority seem to be ok with it.

Guys that had bad outcomes with reversal post their stories on this site, guys like myself, and others post warnings regarding the procedure, yet many still make an informed decision to move forward and have a reversal despite the fact/s.

I tend to believe that outcomes with spermatic cord de-nervation, neurolysis, etc aren’t a whole lot different than let’s say reversal, yet I am aware these procedures are completely different animals, have their own risks, benefits, etc. Like reversal, de-nervation likely has a wide spectrum regarding if it helped, how much it helped, not helping, being made worse, and so on. I’m sure, many get near complete resolution~ with SCD, but I’m certain it’s not everyone.

We’ve had many guys post stories on this site that they were never warned about being made worse by SCD, neurolysis, reversal, and so on, and that’s not cool. As long as men have been warned beforehand, and are making informed decisions regarding their choices, I’m thinking that’s what matters the most.

I realize that telling people about the bad outcomes doesn’t encourage them to follow through with something that may be beneficial to them, but… the majority of us have strong reservations in regard to people making informed decisions beforehand regarding vasectomy, and I don’t see how this is any different.

I wish the best of luck to anyone considering any version of de-nervation, or some of the other procedures getting some attention in this thread.


#40

It’s all a roll of the dice.