I went to a different urologist 2 weeks after the vasectomy. He felt down there and said there was a small sperm granuloma, but he wasn't concerned. He said it may take 4-6 weeks for the nerves to get use to it (or something like that, can't remember exactly) and for the sperm granuloma to reduce in size. He gave my amitriptaline 25mg to take once a day, before bed. He said it would help with nerve pain until that happened. He also gave me a low dose of hydrocodone/acetaminaphine for pain, if it flared up.
I too seem to have more flare-ups if I walk to much or on my feet a lot, but it is more of an uncomfortable feeling. Some days I feel like I am getting over the hump and then others I'm back a few days. I do think I am a lot better than the week after the surgery, but I just fear the future.
I'm not sure when the sperm granuloma occurred exactly, it could have been at surgery, it could have been when we first had sex, but that would seem weird, since I had the pain I am describing, before that occurred.
I will say that I don't have pain when I actually ejaculate, and I don't have pain in the testicles. I too though have a knot feeling at the vas spot and it seems around that area is where the pain is coming from, so I think it is irritating the veins and nerves causing them to become inflamed. Just trying to go day by day. Looking for the light at the end of the tunnel, but not seeing it yet.