This is a long one....but hopefully the detail is helpful
MY PAIN RESOLUTION STORY:
I am posting this in the hope that it may help just one person who has similar symptoms as I did. The info out there is terrible and no one will be able to identify the source of your pain unless you do your research, pay attention to your body, and hopefully find a good surgeon to make it happen. Good luck….my story:
My Post Vasectomy Pain symptoms:
•Pain after sex not immediate,
•pain behind and above left testicle (targeted epididymis and at cyst/granuloma site)
•Usually dull ache - after nerve bloc sometimes sharper now
•Occasionally get lower sick in the stomach feeling like you do get after being hit in testicles
•Pain when crouching
1\13\2012 - vasectomy operation
1.during surgery had much more pain sensitivity on left side - required additional shot of anesthesia during operation.
2.No other complications noted
2-3 weeks post surgery - right side no pain, left side still has significant soreness. I called dr. Office and they said it was normal and to continue w anti inflammatories. This persisted on and off for next few months but eventually tapered off to mild discomfort on occasion.
9/01/2013 - beginning of left testicular pain.
1.Developed substantial left testicular pain and setup appointment w/ urologist who performed vasectomy.
2.At meeting he noticed an epididymal cyst or sperm granuloma on left textile. Was very tender when checking. Prescribed anti inflammatory medication.
3.Over next few weeks I tried advil 800 mg and allege 400 mg w no significant improvement.
4.Ultrasound ordered - results showed an epididymal cyst. Urologist said it was normal looking and very common post- vasectomy
1.was given cipro to treat symptoms - after 5 days I stopped taking due to reactions ( not major). Moved to 10 day dose of bactrim.
2.Had 3 days of relief towards the end of the first bactrim course. It coincided with a beach vacation including hot tub time and cool water swimming.
3.Pain returned when I got back from trip. Went on 16 day course of bactrim again with no improvement. Ending mid October.
1.Another visit to urologist prescribed another course of anti inflammatories and a "wait and see approach for one month."
2.Followup appointment mid November still have general pain...reviewed options w urologist moving forward
3.3 weeks later visit. W nurse practitioner and doctor ordered a nerve block test
1.Nerve block performed
a.Pain during nerve block was extremely high...almost off the charts
b.After nerve block no pain in testicle but had the lower abdomen discomfort and minor "stomach queasiness that occurs after getting hit in testicles"
c.Significant bruising in 2 areas of left testicle next day.
d.Pain increases over next few days and becomes unbearable by mid week.
e.Made an immediate appointment w nurse practitionet wed am to get pain medication to take pain edge off (given 5 mg pills of _______ to help w pain. (I can only take 1\4 to 1/3 of a pill at a time and still function)
2.Follow Up call w urologist was returned w a message but never got the chance to discuss my results as I don't know how …. need to see someone else...
Second Urologist Visit (Specializes in testicular pain): I finally found someone who was confident they could resolve my issue (please note I worked w/ him for a year until we figured it out...but we only needed to do 1 surgery).
My second urologist specialized in Post Vasectomy Resolution, using reversal and Spermadic cord denervation techniques when he saw fit. I figured he would be the one to cure me if anyone. As I quickly found out, there is a standard routine to troubleshoot this pain issue that we all find out...anti-inflammatories, antibiotics, then another round if that doesn’t work. If dealing w/ a specialist, next comes the nerve block to see if denervation could work. In my case, the nerve block never took away the core pain (even though I considered convincing myself that it did. After the second nerve block I knew that wasn’t the fix. I didn’t have a nerve issue, I had a congestion issue. (I remember at one point, my original urologist wanted to prescribe me a nerve medication. I thought it crazy to treat my localized issue w/ nerve medication and passed that up.). It seemed that the cord denervation was not going to solve my issue and vasectomy reversal was the next course unless we came up w/ something else. I really did not want any more kids and was concerned about the overall cost of the procedure, luckily I found another option.
My pain resolution:
After much research and discussions w/ my urologist (and a second opinion from my origianl one who did the surgery) we decided that congestion was my primary issue. The core pain was always in the back of my left testicle. It radiated upward even as far as my lower abdomen at times. This made it hard to diagnose originally until I really spent time trying to nail down the source. I think the kicker was the night I put direct pressure and massaged the back of my testicle for a bit to see what would happen. The next day or two, I paid for it w/ much increased pain, but I got my answer. I found a website from a doctor in Canada who supposedly had great success converting closed-ended vasectomies to open-ended with much success. We decided that conversion to an open-ended vasectomy was the least involved resolution and would still keep the birth control side in place. It would allow the sperm to drain out and relieve the congestion. They laid out a 50/50 or 60/40 chance that this would work...I decided to take it. They also warned me that a granuloma is sure to form and may or may not cause me pain (I could take that risk too).
After the surgery: (Surgery November 2014) My doctor said that during surgery when he cut the closed left vas, fluid shot out across the room...showing that epididymal pressure was playing in to the issue and causing the majority if not all of my pain. The first few weeks after the surgery were concerning as the epididymal pain was gone but new pain around the incision was there. It took a good 3 weeks until I stopped freaking out and saw consistent signs of improvement (its no quick thing). As of now (2 months later), all of the pain in the back of my testicle is gone. I can finally wear boxers again on occasion and not jockstraps all of the time (which were a godsend for my pain originally). There is still some minor discomfort up towards the top of my testicle around the vas area where the incision site is. It is improving daily and I believe a lot of it is due to the disolvable stitches that are still working their way out. That being said, this discomfort is NOTHING compared to what I’ve been going through for the last 2-3 years. I can live with this with a smile on my face…:-)
In conclusion: My original urologist was great and did exactly what he was supposed to do for a vasectomy and did it well. My body just rejected the notion of blocking my left vas. My second urologist specialized in Post Vasecomy Pain resolution. Even he didn’t have the quick answer that I and everyone else expects. From my discussions w/ both of them, every case is different and this syndrome is the most difficult urology issue to diagnose and treat. It took much research on my part, paying attention to my body and how the pain works daily, and many visits/consultations w/ my urologist to finally come up w/ a attempted solution. He never tried this technique before, but I presume he may add it to his list of possible solutions now. Luckily we have great Surgeons in the DC area and that is always a big leg up when dealing with such a sensitive area. Good luck.