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Micro-Cryo Ablation of the Spermatic Cord


#1

I had my 3+ month denervation follow up with Dr. P yesterday. While I am doing better as long as I’m on the Gabapentin and Meloxicam, when I do not take it, my pain levels return to pre-surgery levels. Therefore, we have decided to go ahead with the cryoablation. The reasoning, I believe (Dr. P can correct me if I’m wrong), is this: since I had a 100% resolution of pain with the initial cord block procedure (at least for 6 hours), the pain is nerve related. The denervation did not ligate the specific nerves causing the pain, but the block did, so waiting for additional resolution of pain from the denervation will probably be fruitless. With the cryoablation, he will target other nerves in a different location. I have only spoken with one person who has had this procedure done, and am wondering if other members of the forum have had the procedure, and what their results have been. Even on the old forum, I couldn’t find out much about it. So, guys…any insight on this?

Don H (formerly Deltona_don)


#2

I haven’t had the cryoablation done, I’d also be interested in knowing a little more.

From the http://www.mypur.org/#!chronic-testicular-pain/c4oy :

Cryo-ablation has been used successfully in the past for peripheral nerve pain syndromes, but the older techniques utilized much larger cryo probes that required more extensive and open exposure techniques. We now utilize the world’s smallest micro-cryoablation probes to provide a minimally invasive technique to perform ultrasound guided targeted micro-cryoablation of the genitofemoral and/or ilioinguinal nerves. The image to the right (or below on mobile phones) illustrates the technique. We are the first center offering this procedure and are the official credentialling and training site for surgeons who may want to perform this procedure. Currently, we are the only center performing this procedure. We usually get about a 70-75% success rate in significantly reducing pain in patients who undergo this procedure.

It would be useful to know how a ‘succcess’ is defined. In many studies I’ve looked at, success is usually defined as the pain has been reduced significantly, but not necessarily entirely. It’s also useful to find out how many times this procedure has been performed, and if there are any any published research papers on the topic?

Maybe @S_Parekattil_MD or Dr. Brahmbhatt can comment on this.


#3

My impression is that the cyro ablation is not considered to be a permanent fix (the way that the targeted neurolysis is.) Is Dr. P. suggesting that you do this as a way of pinpointing the affected nerves? I’m curious to know what would be done if the c-a provides temporary relief. Maybe a second neurolysis with new targets? Or, the traditional procedure where everything gets ligated? Of course, I hope it isn’t an issue. I hope it is a permanent fix. And, its good news that you seem to be on to something!


#4

Tim,

From what I understand, the cryo is considered permanent as they ligate nerves by freezing them rather than the surgical procedures used in the denervation process, and although Dr. P said they haven’t done enough of them to have a long range rate of success, that most of the men who responded positively still had significantly reduced pain after a one year follow-up. It’s the Botox injections that do not seem to be permanent.

Don


#5

Hey Don, I was going on memory of a discussion that I had with Dr. P. about the cyro after my wife had radio frequency ablation for her back. We were told the radio would be good for a year or so. I thought Dr. P. said that he expected the cyro to last longer, but not with the same permanence of the neurolysis. Anyway, I’m really hopeful for you. It seems pretty clear that it is a nerve issue. Hopefully he’ll be able to hit those nerves with the cyro. Has he talked to you about recovery? What’s that supposed to be like?


#6

We didn’t speak that much about recovery, except that he said it was less invasive than the neurolysis and that recovery should be quicker. My recovery with the neurolysis was pretty good, I never got the “tennis ball” swelling, and overall, I think it went well.

What I did ask him was how long it would take before I would notice any relief of pain. He said it could be 2-3 months, as with neurolysis. I remembered your post regarding RF ablation (from reading your previous post) and asked him about that. He said that RF heats the nerve, and that cryo freezes the nerve, and in his experience, he has had better outcomes with cryo when it comes to nerves in the spermatic cord.

I’m scheduled to have it done on Jan 27th, but that is pending any kind of approval from the insurance company, which was a problem with both the cord block and the neurolysis, they say it can take 30 days for an approval or denial. So right now I’m on ‘hold’ waiting to see what Dr. P’s staff can do to push this through.


#7

Okay, it looks like Dr. P. and his staff pulled off another miracle. The insurance company approved the cryoablation today, and the surgery is on for Monday. Although I’m going into this with a LOT less information than I had with the denervation, I guess it’s no less that the information that used to be provided to patients years ago, Dr. P. explained to me what they will be doing, so I understand the basics of the procedure. I just wish that there were videos of the procedure the way there are for the denervation. I’m a visual guy, as I think most men are, and as I have mentioned to Dr. P., just seeing what will be done is somewhat comforting, and takes some of the fear of the unknown away.

Unlike the previous procedures I have had done, I won’t need to stay overnight at a hotel, like I did in Winter Haven. His new office is close enough to where I live, I have friends who will be able to drive me home. That alone makes me feel better, knowing I won’t have to spend the night after surgery sitting in a hotel room, unable to drive, and going stir-crazy.

So, here we go again, on the quest to end this pain. Wish me luck, and I’ll keep you all posted.


#8

Good luck Don! Happy to hear its going to be a smooth trip. U are blessed in that way to be so close to Dr. P.


#9

Best of luck Don and a speedy recovery from this mess. You’re in good hands.


#10

Thanks, guys. Much appreciated!


#11

Good luck, I think we all agree your in good hands there with Dr. P


#12

Don, I fully agree. And I do feel very fortunate to have found him and for him to be so close. Makes seeing him for follow-ups, etc. so much easier. I know he has all our interests at heart and I find it truly remarkable that he has devoted his practice to this endeavor.


#13

Good luck Don. I am sure you will do great.


#14

Thanks again guys, the cryo was done this afternoon, and Dr. P said everything went great. I had friends drive me home and am now going to be relaxing around the house for a few days, taking it easy. I don’t notice any difference in the levels of pain, but it is WAY early, of course. He said to give it a couple of months to see if there is any reduction in the overall levels of pain. So I’m in the waiting stage now. But it’s over, and for me, it was no big deal, went to sleep and awoke about an hour and ten minutes later. So far, I’m not having any ‘surgical’ pain or pain from the incision, but I’m back to taking the ‘regular’ meds, Gabapentin and Meloxicam, and now am adding an antibiotic and Lortab (if I need it…haven’t so far).


#15

It has been 24 hours since the cryo ablation, and so far, I feel great. It may be psychosomatic or the lingering effects of anesthetics, but I swear the pain in my right testicle is greatly diminished. Additionally, there is very little pain at the incision site, almost as if I had nothing done. No swelling, no bruising, just the small scar. I just pray that this feeling remains, because if it does…I think it might have done the trick! Having had the denervation as a basis of comparison, this time I really do think there is a significant level of pain relief. Thank you Dr. P.!!!


#16

Awesome news Don! Hoping for the best in your recovery.


#17

GOOD FOR YOU… Wishing you all the best Don


#18

That’s awesome! Keep us posted as more time passes. OK?


#19

I certainly will, Tim. Oh, and because of your post regarding the temporary results of cryo, I did ask Dr P prior to going into the OR if this would be a temporary fix, and he said no, the way they do the cryo, they expect permanent results.

As of this morning, I still have no testicular pain, but I can tell you that there is some pain at the incision site…irritating, but not awful.


#20

Sounds good so far, hoping all the best for you. that’s great news about it being a potentially permanent solution !