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My story of pain resolution using an open ended conversion


#1

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

Timeframe/history

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

9/19/2013 -

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.

10/15/2013

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

12/13

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…:slight_smile:
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.


If you have congestion pain, could this help?
#2

I am glad that this worked for you and thanks for sharing.


#3

Hey Scott, great to hear this worked for you. I live in the Washington DC area as well - could you pass along the name of the Urologist you saw? It would be nice to get another opinion from a doctor who treats PVP. I’m not sure if my issue is congestion–it may even be muscular–but I would like a different opinion nevertheless. Thanks.


#4

Great story. But what do you thing the chance is that the open end will still close?

I’ve had an open end vasectomy myself and purposefully chose for the open end technique because the chance of congestion pain would be a lot less. But after I started getting pain from it, the person who did the vasectomy told me the open part will close eventually. So, I’ve read different things on this. On one side, I remember reading about the granuloma as being the sort of donut shaped scar tissue that would ironically keep the vas deferens open. And on the other side there was my docter telling me it will close anyway and also on other anti-vasectomy sites telling me the chance that it will close is very big. So I was very disappointed about that and never believed anymore that this would be a solution for life.


#5

6 months after the open ended conversion, i have only 5 percent of the discomfort if that…i am hopeful it remains this way…its been a huge sense relief. I have no reason to believe it will take a turn for the worse.


#6

Great to hear some good news and thanks for sharing. As has been said please pm me and let me know what docs you have seen in the Washington DC area (sorrry I did not see a location in your original post but saw another mention it so I hope that is correct)


#7

Dr. Fenig with chesapeake urology was the doctor who did my open-ended conversion.


#8

Scott,

Hey Scott, I saw Brad Lerner of Chesapeake at one point myself. I’m going to send you a PM. It turns out another guy on our site is practically a neighbor of mine and got his vas at the same group as me. 1 in a thousand. Yeah right.


#9

Guys, I’m interested in the open ended conversion option. If congestion is the cause of the pain it seems like a pretty simple solution. Also, if scar tissue or irritation from the clips is causing the pain the open ended conversion would help as well. So, why isn’t this procedure tried more commonly? What are the major risks? @scott, were you able to get insurance to cover it?


#10

Hey Tim I did read your post, sorry to hear your still having problems.
I did look into this option after seeing a specialist that does reversals. He does open ended vasectomys as well and has done a few conversions to open ended for pain resolution. I had a couple of resons for not going that way, my problems were not just congestion, he said if that didnt work he would do reversal and if that didnt work denerveation. The sperm leaking into the body just dosent sound right to me and also there is the chance of granulomas being painful. I didnt want to take the chance of it not working then having to be cut open again. The recovery from open ended would be far better than reversal, my recovery has been pretty slow and painful so far but hoping in the long run it will be worth it. Even though its taking this long im still glad I went this way.
Have you read some of the info on the web sites from the top reversal specialists in America, there is a lot of info about open ended conversions for pain resolution and reversals.
Thats my thoughts on it anyway, its a hard decision to make but I felt better once I had made a decision on which way I wanted to go.
Hope this helps.


#11

Tim,

I think if you just have congestive pain this is probably a good way to go. You are essentially choosing where to put the weak spot in your vas on the epi end. I would imagine it will reseal but act like a pressure release valve. If you have nerve pain, sharp stinging/burning etc, without a testicular component then it makes less sense.

Good luck.


#12

Hey tim, From my research, the open ended conversion isn’t used or suggested more often because there aren’t enough studies done and published. Until that is done, it wont be included into the “recommended process” given by the urological associations. Until that is done, the only way it will be part of the conversation is if you are lucky enough to be working with a doctor who had has experience dealing w a wide array of these issues…(that all is my opinion, may not be fact).

My insurance did cover my open ended conversion. My doctor just listed it as something like a vasectomy revision. The insurance looked at it as an complication of the original surgery. The reason i chose the open ended conversion vs a reversal is due to 3 reasons: 1. Financial- my insurance company covered the open ended but probably wouldn’t cover the reversal. As you probably know, they don’t want someone saying the reversal is for pain resolution when someone wants to just have kids again and looking for a free operation. 2. I got the vasectomy for a reason ( i don’t want any more kids and i don’t want to have to wear a condom during sex w my wife). That was the driver for my decision.

Im 8 months out from my open ended conversion and happy with my decision so far. To be honest that testicle still has very minor discomfort on occasion vs my other one, but going from a pain level 8 that i was dealing with to a 1 that I only notice occasionally is a walk in the park. I am presuming the 1 is what they talk about when they say a granuloma can be painful. After going through the original congestion problem for 2 years (as you may know) this is nothing.

Every case is different but for congestion, I’m all for the open ended conversion…so far :slight_smile:


#13

Scott, it sounds like it has been a great solution for you. Will the granuloma go away over time? Or, do you have the option of having it removed? (I suppose a new one would grow in its place though?) I’m still really surprised that the open-ended revision isn’t done more often. Your reasons for preferring it to a reversal make total sense, and I would expect others would share that same line of thinking. My issue is that I just don’t know what the cause of my pain is. My symptoms aren’t always congestion sensations, though that’s certainly part of it. Lately, the pain has been testicular acheyness. Poking around down there could just make things all the more angry. Or, it could work. What I need is a crystal ball!


#14

Hey tim,

From what i found, the granuloma will be there forever. It is how the vas allows the sperm to “leak out” a bit which is what is helping w my congestion. I definitely wouldn’t go back in to get it removed at this point. I’m always cautious of surgery and to only do it when needed. I don’t think my left side will ever be totally free of any discomfort like the right side but i really need to concentrate to notice it. I don’t notice it otherwise.

Achieness was one of my major symptoms. I noticed that if i rubbed the back of my testicle (near the epididymus) w the same pressure that i could tolerate on the other side, the ache would jump for a day or so. That was my sign that the epididymus was not tolerating the vasectomy and needed relief. That being said, my doctors told me there was a 60/40 chance going into it. I figured the gamble was worth it and if it didnt work, we had at least eliminated one possible cause.


#15

A granuluma is found in all men that have an open ended vasectomy. It is vaguely considered acting like a magic valve that keep things open. But when I had problem the doctor that did my vasectomy said it will eventually close. I suggest you do some more research in that to find out what’s true.


#16

That’s all fine and good. I’m not trying to debate the medical science side of it. That’s what our doctor’s are for. I’m just trying to share an option that should be considered. Understood I’m only 9 months out from it, but things are so much better (not 100% discomfort free). The pain doesn’t consume my thoughts anymore and I barely notice anything. If it’s closed up now, then whatever the change was is a great outcome.


#17

Hey scott, it seems like I might be in a similar situation as you.

I had my vasectomy (closed scalpel) in September and had some twinges and pains during the first month and then occasionally during sex. About a month ago, things got worse and I’m definitely feeling the pain. Some symptoms include:

  • Sensitive testicles–it feels like I’m being love-tapped every time I graze my balls.
  • Kicked in the balls feeling–the soreness and the nauseous feeling in the lower stomach
  • Painful scar tissue area–it feels like a pea and hurts to touch.
  • Sharp, stabbing pain-- when I’m aroused, the scar tissue area swells up and I get stabbing pain
  • Soreness/pain after ejaculation
  • Feeling “constipated”–it feels like there’s pressure/fullness that I can’t get out
  • Pain from the side of the scrotum to the bottom abdomen

Did you experience any of these during your time with PVPS?

Luckily I live in MD, so I can see Chesapeake Urology and probably will to get a second opinion, and if possible, a vasectomy conversion.


#18

I wonder why your doctor gave it a 60/40 chance. Was he speaking in general terms just to say something like, “It is reasonable that this would work, but it hasn’t been studied much and I can’t give any guarantees.” Or, was he thinking more specifically about your symptoms, likely sources of pain, possible complications, etc.? …I’m really glad that you shared you experience @scott. A conversion really does seem like an important option to consider, especially when a much more complex and expensive surgery such as a reversal is also an option. What was your recovery like from the conversion? Were you knocked out for the procedure? I assume it was outpatient, right?


#19

Hi Bryan,

I did experience many/most of the same symptoms as you listed. Sounds like your issue was similar to mine. Of course only my left testicle had the issues. My right was never an issue. It would be worth a trip to see Dr. Fenig to review your symptoms. Good luck.


#20

Hi Tim,

It was definitely more of the “it sounds reasonable, but hasn’t been studied much answer”, but still taking into consideration my symptoms and sources of pain. Since the cord blocks never really worked on my main source of pain (only some minor pain that came from the top and radiated upward. I was put out for the procedure and it was outpatient. The recovery was longer than my original, but not terrible. It wasn’t an immediate pain free situation as the general surgery pains had to heal before I could really tell things were working…although I had a feeling that the major pressure issue was gone. That all being said, as some stated before me, the granuloma that exists now does have some minor irritation on occasion, but it’s really minor compared to before. I only notice it for a few minutes every few days. But if you’ve been through the same pain I had and many on this forum have, it’s nothing.