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Is the Phrase Post-Vasectomy Pain Helpful?


#1

As I research therapies, I got to wondering if using the diagnosis PVPS is helpful to us. Clearly, we’ve all been injured by vasectomy, no denying that. As I read the Dellon Institutes website and as I speak with Pain Management specialists, it’s clear that they accept vasectomy as a cause, too, even if many urologists do not. But, other surgeries and sources of injury result in chronic pain, and we don’t include them in the diagnosis phrase. For example, there’s no Post Hernia Repair Pain Syndrome and there’s no Post Testicular Removal for Cancer Pain Syndrome, yet these two surgeries DO result in chronic pain in some instance. There are several women’s surgeries that result in nerve damage and chronic pain.

By retaining vasectomy in our diagnosis phrase, we DO put heat on the urological community. We need to do that. But, honestly, I don’t think the urological community offers much hope. Let’s sum up their remedies:

  1. Reversal - decent results, especially for congestion, and for clean out of damaged tissue.
  2. Epi Removal - poor results
  3. Denervation - poor results
  4. Pain Meds - we can get those from other physicians

With the exception of Dr. Parekatill who offers therapeutic (mega) cord blocks, cryo, and botox, that’s all the urological community offers its victims. I can’t think of any others.

I say all this because so many were surprised, myself included, when my Pain Mgt. physician suggested pulsed RF ablation of my GF. If this works for me, I’ll be elated but also very frustrated that it took 15 months to find out it was even an option. I thought blocks were all he offered. I’m not frustrated with the doc, but frustrated with myself for not seeing him more frequently and pushing him for alternatives. Instead, I’ve been wasting time in urologists offices whom I’ve now concluded offer no real hope.

My urologist even made it seem like denervation is a no-brainer if I have a positive response to a cord block. Given my positive response to Dr. P’s mega block and my positive response to Pain Mgt.'s GF block, I’m sure his in-office cord block would work and suggest denervation, but based on everyone’s experiences here, I can’t imagine taking the risk given other alternatives exist.

At the advice @Acschiro, I read about Dr. Dellon in Baltimore and wish I’d have found him or similar much sooner. His approach seems so much better than what uro’s offer in denervation.

Sorry for the rambling. I guess my point is that I feel that by looking at this as a vasectomy problem (PVPS), I personally have been looking to urologists to cure me. If it’s scrotum related, see a urologist, right?

Not so sure about that anymore.


#2

That’s an interesting thought @raising4girls. In my opinion, I believe that the right first step after vasectomy is to deal with a urologist that focuses on PVPS. Meds, time and conservative therapies often work. Next option for most would be reversal, which seems to work for many, so seems like the next logical approach. If after reversal you are still having trouble than a multi modality treatment group would be your best bet. Sadly, it seems most physicians won’t recommend this and will keep pushing their treatment options on you. This appears to be the case with a few of the PVPS specialists. Although those options often help, it does seem that some of the unluckier few on this forum are actually made worse. Currently I am sticking with my uro and a new GP that is willing to work with me on some conservative options. If things don’t continue to improve or worsen, I will reverse. If that is unsuccessful, I will then broaden my treatment team to pain management, neurologists, etc. Good post man.


#3

Thanks. I see your point.

This whole diagnosis thing has me thinking. Suppose (hopefully) for example that I get relief from ablation or removal of my left GF nerve. Did I have Post Vasectomy Pain Syndrome or did I have Genitofemoral Neuraliga? Perhaps this is a semantic point with no real answer.

But, I’ve noticed that Pain Mgt. guys don’t spend a ton of time discussing the past (cause) but DO spend a lot of time on symptoms, focusing on WHICH SPECIFIC nerve is feeling the pain. I’ve seen 5 different urologists and only one (Dr. P.) posited that I could have damaged the II, the GF, or branch of pudendal nerve. Maybe they were thinking it, but they never said it. The Pain Mgt. doc seems more willing to discuss the potential pain source, how to isolate it, and what to do about it.

As I think about it, I think it has to do with the tools in the uro tool kit. Uros do cord blocks without isolating the culprit nerve if only one is the cause. They do denervation which removes nerves in mass without trying to isolate the one (if only one is a culprit). They offer pain meds which, again, are an en masse solution.


#4

Exactly if your problem is not congestion related then only a handful of urologists are even qualified in my opinion to deal with us. Most just throw antibiotics and antinflammatories at it. You are better off dealing with a peripheral nerve surgeon, surgeon trained in hernia repair nerve injuries or pain mgt specialist. Anyone who has immediate pain after their vasectomy should be referred to pain mgt as early as possible to determine if it is nerve related and try to stop the pain from becoming centralized and chronic. Urologists policy is wait 6 months and see if it improves in my opinion this is basically medical malpractice in itself. By waiting 6 months if it is nerve damage you may have missed the window to rid your pain forever and have the chance of RSD crpsII or centralization of pain developing due to the nerve injury. All types of surgeries can cause nerve damage and lead to crps II and centralization of pain but they are referred quicker to pain mgt and receive earlier treatment because the surgeons admit that they should not be having pain post surgical past a certain timeframe and know time is of the essence in treating the pain. Urologists just don’t want to admit that their quick snip caused anything so they drag it out for months or years just hoping you will go away with the “I’ve never had anyone have problems after a vasectomy”. If they would just be honest and admit this surgery can have complications and refer accordingly I know a lot of the guys on this board might have suffered less. First of all this procedure should only be done under general anaesthesia and with high powered microscopes due to the anatomy and size of the nerves in my opinion. (I know I read someones post on here who had a neurosurgeon I believe give that quote in court to prove his injury was nerve related and could have been avoided if the procedure was done properly). Then why do I personally have 5-6 patients I see in my office alone who have pvps symptoms??? For anyone new to the board I beg you if you developed immediate symptoms after your vasectomy reach out to either a good pain specialist preferably anaesthesiologist experienced in blocks or a urologist like Dr. P or Dr. Savenaugh at Cleveland clinic who treats pvps regularly to determine if it is in fact nerve damage. I waited 4 months till my first blocks and should have had them done immediately I had nerve related pain during the surgery and immediately after but went along with the let’s ride this out it will get better. If I could go back 3 1/2 yrs I would have had blocks done within the first month and if positive nerve removal or rf ablation immediately to try and avoid the centralization of pain I now have that will probably be with me till I’m gone. I’ve have had all the mainstay procedures performed reversal denervation cryoablation Botox stem cells testicle removal, acupuncture chiropractic, PT, cord blocks, etc etc Besides choo choo on this board I’d say I have researched this more and have more knowledge about the anatomy and treatments than the average urologist you would see. So learn from my mistakes and the time I’ve put in to researching this and seek early treatment from a true specialist in nerve related injuries especially if you have developed pain in the spermatic cord and especially tell every guy you know to never ever have a vasectomy!

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#5

Lots of good info here. I agree that a urologist is probably the last person you should be calling on to fix this problem. I cringe when guys discuss further treatment done by a local urologist. It seems like the right thing but it simply isn’t. Unfortunately, medical specialties are divided by anatomical location. Uro procedure done by a uro in a uro location. Common sense says to see a uro for the problem but this type of problem is well above and beyond a urologist. There are very few trained in the management of peripheral nerve damage. I also agree that the term PVPS throws some of the blame in their direction and probably doesn’t help our cause, at least when talking to uro. Further, it may be difficult finding a nerve guy willing to work in the area overseen by uro. More rambling but overall a good post. Central Sensitization is brutal. Some days o wish it was just my testicles that hurt.


#6

Is this the same thing Jess tried?


#7

Thanks. By the way, word I get here around Cleveland is that Dr. Sabanegh is moving up into executive management at the Cleveland Clinic beyond just being in charge of Glickman Urological Institute. It took me 6 months to get an appointment. I assume based on that he’s seeing few patients. The other one in Cleveland is Shoskes, but he does denervations, not reversals. I like him but given the experiences of PVP sufferers with denervation, I’m not sure how much he can help us.


#8

I thought Jesse had denervation.


#9

He had something like that done recently. It was a device placed in his back I thought. I’ll have to go back and look.


#10

Yes, I remember. I think it was dorsal root ganglion related. Maybe a cord stimulator.

Ablation is much different. As I understand it, ablation removes the sheath surrounding the nerve that conducts the signals. It basically destroys the nerve, but doesn’t sever it into separate pieces as I originally thought. Downside is that the sheath does regrow over time so the pain can return or even be made worse.


#11

This is a very good point. At a certain point you don’t really have a urological problem anymore so urological treatments may be worthless. It’s the classic “if all you’ve got in your toolbelt is a hammer, everything looks like a nail” problem.

I may go back to Dr. Dellon here for another GF block to see if that helps me.

We are in many respects similar to mesh hernia patients that end up in pain. My testicles are not where my pain is. It"s where my urologist accessed the vas that hurts. I don’t think a urologist can fix that.


#12

@raising4girls makes a very important point.

If there’s one thing that I’ve learned about informed consent and post-surgical complications, it’s that chronic pain post-surgery is much more common than you’d think, yet chronic pain is rarely if ever listed as a complication of surgery.

Vasectomies are the 2nd most common surgery performed on men. Circumcisions being the most common. You don’t hear about the 150 or so infants in the U.S. who die every year from circumcision, but it happens. Although statistically death from circumcision is incredibly rare, those are deaths that DIDN’T NEED TO HAPPEN!

I think the reason PVPS became a moniker is because of how common it is. When you consider 500,000 vas’s done in the US every year, statistically there will be 5-10,000 in chronic pain that affects quality of life. Those numbers are staggering.

I’ll add my .02 about post hernia repair pain syndrome - when I had my hernia repaired at shouldice in Toronto about 7 years ago, I specifically asked about risks from the surgery and was told there were basically none other than the usual bleeding, death blah blah, but nothing about post hernia repair pain syndrome, which is quite well documented.

Look online at almost any hernia repair center’s website and they don’t say a damn thing about chronic pain!

I should note that I did have some pain for about a year after the repair, but it really wasn’t bad and it eventually healed to 99% better, with the occasional twinge or discomfort when lifting something really heavy. So in the end it was worth it, considering before the repair I had this nasty bulge spilling out of my gut and I had to be careful lifting stuff.

My point is that doctors don’t really seem to think of chronic pain as a complication from surgery. That’s wrong on so many levels. The human body isn’t fixable when it’s damaged, unlike a car or a house. There’s no turning back once the damage is done and every patient needs to be given the most uptodate (see what I did there) information on complications from surgery, not just life-threatening, but life altering, such as PVPS.


#13

What kind of hernia did you have? Pain after inguinal hernia repair is apparently very common and can be very debilitating.


#14

It was a direct inguinal hernia. Fairly small.

After the hernia surgery my balls swelled up to the size of tangerines for about a week, and then I was fine. I figured the vas would be fine because of that experience. Ha. right.

But I made it away from the hernia surgery with no issues, and I certainly didn’t heed the doc’s advice, lifting heavy stuff in the first week, etc. Not smart in hindsight, but never had any problems afterwards fortunately.


#15

@Acschiro, I was just reading this post and grateful for the honesty of these posts so we can try to figure out our issues and options early. I have had pain that didn’t seem right after the surgery but started noticing the possible nerve pain about a week later in hip and back. I am pretty sure I have nerve damage but not sure how many are impacted yet. I know the II seems to be impacted with my pain in RT hip and lower back. I sometimes get pains in my inner thighs more on the left than right. After multiple Dr. appointments I was finally able to force the issue to get to a pain specialist who thinks its sciatic nerve and wants to do a block of the sciatic nerve but I don’t think that is the issue. He did mention we could try the II nerve if I do not get success from the sciatic nerve block. He was a younger guy and never dealt with anyone having my symptoms after vasectomy. He was referring to Hernia surgeries. I have a Skype call with Dr. P Tuesday which I hope can provide some good options since I am not convinced the issue is sciatic nerve. I am Day 39 post vasectomy today. I am wondering if anyone has tried to have the II nerve cut higher up similar to Hernia patients and if that worked?


#16

@Acschiro and @Choohooo are providing great research for this forum. We’re forever indebted. Dr. Ellis provided similar medical expertise on the old Yahoo forum.


#17

Ben pain in inner thighs is not sciatic nerve. The sciatic nerve runs down buttocks and posterior or back of thigh. The Genitofemoral nerve is most likely the culprit. Look up sensory nerve patterns of the genitofemoral nerve
they are medial thigh, groin and testicle pain. If you had no lower back hip or thigh pain before the surgery and immediately after it starts it’s obvious the damaged nerve is either genitofemoral ilioinguinal or iliohypogastric. I don’t know why all of
these doctors always insist to look at the back it’s like they don’t want to admit you were damaged from the surgery! 1 + 1 always equals 2 but they seem to think it can equal 3?

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#18

@Ben

Take a look at the diagram. These are zones are called dermatomes. It shouldn’t be that difficult to figure out which nerve is involved unless you have damage to more than one. Post vas sciatica is very rare unless it develops later. Damage to the ilioinguinal nerve can create core muscle weakness that will ultimately take out your back which will in turn create sciatica. In such a case, L5-S1 is most often affected.

Hope the pics help clarify what’s going on. Show them to your doc if you need to.

image


#19

@Ben you are in early stages yet. At only 6 weeks your still healing inside. Wait till at least 25 weeks and see how you feel. Some people do get relief with time.


#20

This is interesting. I feel referred pain in my hip, somewhere on the outside on the right side.

I just started pelvic floor therapy 2 weeks ago and the PT found issues on my right side with my oblique and hip flexor. He said my lumbar gap in the spine was slightly compressed but nothing too narrow. he found knots in the muscles that can then in turn pull the spine closer together, further irritating the nerve.

I had some weakness on that side when I was doing the leg extension exercise while prone. So now I am working on a battery of exercises to strengthen those muscles around. I am also forcing lumbar support when I sit.

He’s optimistic that I will get good results. He also thinks I had a buildup of slouching with age and the vas put me over the top. If it doesn’t go away in a month he’ll recommend dry needling on those muscles.