My story of pain resolution using an open ended conversion


Hey Scott,

I’m trying to get an appointment with Chesapeake Urology but want to see if my insurance will cover an outside specialty. What did you do throughout the process? Did your insurance cover any/all of it?



My insurance covered the majority of the costs, the same as my original surgery. They coded it and it was considered a vasectomy revision. Luckily I have BCBS and my plan allows me to see any doctor so i didnt have any in-network issues.


Wow both you guys are Maryland guys? I am here in MD myself. There is at least one other guy on this board that is practically my neighbor. You can PM me of you don’t want to broadcast your address or general location.


I am writing you regarding my current problem with PVPS. I had a closed vasectomy performed 4 years a ago. I never had problems until about 10 months ago. I had an initial incident where I jumped down from a height and I developed right testicular discomfort and subsequent epididymitis. Treatment seemed to relieve the problem (NSAIDS/warm baths). I have since had 4 additional bouts of pinpoint inferior epididymitis with focal swelling at my left side and now 10 months later I am experiencing a minor event on my right again. I have been on several rounds of Bactrim DS (30+ days) thinking that there was a small chance that the epididymitis may have lead to an infection that would not clear. So far the left side is fine… For now.

I have seen both the urologist that performed the vasectomy and a second urologist that he sent me to at the local university for a second opinion.

I was told that I should consider an epididymectomy if things progress. We never discussed the open conversion technique. I did ask about a reversal but he quoted difficulties with insurance plan coverage for such a procedure.

I would like to resolve this periodic congestion and pain.

Is there a logical algorithm to follow here? What is your experience with open conversion as far as long term follow-up and complications are concerned? Should I consider the reversal? When is it too late to benefit? How successful/dangerous is the epididymectomy?


The main advice you will get here is to not even consider letting someone take your epis. Many here have had to eat huge costs to find relief as insurance companies are worthless. I fought mine and got some money but no where near the cost of the reversal I got.

Keep you epis. Do an open ended conversion or consider neurectomy with Dr’s Parekattil and Brahmbatt at the PUR clinic, which will be covered by insurance.

Another thing that might help you is to see if you can get on testosterone to supress creation of sperm. This might back off the pressure long enough for things to settle down completely. It has been tried by other PVPS sufferers with success especially if your pain is testicular and related to back pressure.


I had similar pain on my left side for about 2 years. Consistant but some days worse than others. Ill tell you from my experience the antibiotics are a complete waste if time if its pvps. I know they need to rule things out but the long term heavy doses will just wear you out…i digress… I am 1 year post open ended conversion with success. Hopefully it stays that way. Insurance covered my procedure. The constant epididymal pressure and resulting pain is gone. One thing to note, chances of developing a granulona are high and i was warned about it. However, the minor occasional discomfort is nothing compared to what i had before. I dont even know its there 99 percent of the time. I consider my open ended conversion a success with less than a few hundred dollars out of pocket cost.


Keep your options open. By that I mean start with the least invasive and work that direction. Epididectomy is second only to orchidectomy. If you remove your epi and still have problems you are in trouble. Reversals are more expensive but it’s one of the few procedures that can provide relief while inflicting minimal negative damage.


I agree completely w Choohooo…i chose my course of action w open ended
using the same theory of going least invasive first (and acknowledging
where my pain is coming from). If its your epididymus causing the pain then
you should really consider open ended as an option. When my doctor was
doing my surgery to an open ended conversion he said liquid flew across the
room when the cut my vas open…that’s where my pain and pressure was
coming from. But funny enough, my right side never bothered me from my
original closed ended vasectomy and still feels great. I have one open and
one closed side. Good luck and keep at it. Took me over 2 years to get
there and I’m sure many others it takes much longer…


Thanks to all of you for the input. My symptoms seem to come on after intense encounters with my wife that result in a long session with lots of anticipation. A few days later I notice a knot in the tail of the epididymis. I assume this is a local blowout due to increased pressure. I have localized tenderness at the knot. I have not experienced constant radiating pain as of yet but I am sure this could become an issue if thing progress. The area becomes tender and requires support when being active to avoid further pain.

I don’t like the thought of an epididymectomy either. Seems too invasive and may leave me with a situation where the pressure backs into the testes resulting in pain there as well. (That is just my logic).

I read at blockages and blow outs of the epi can lead to failure of a vas-vas reversal due to the lack of healthy sperm making their way back to the semen flow in 75-80% of cases. Would this not also hold true in open vas conversions? SCOTT - when your doc did your conversion did they test the fluid at the converted end for sperm? (Just curious - glad it is working for you!)

Seems like the open ended conversion vs. a vas-vas or vas-epi reversal would be the best options. I am not concerned at this point about the restoration of fertility. We will just make other arrangements in that department if need be.

Are any of you familiar with Dr. Silver at the infertility clinic of St. Louis? I guess he pioneered the microsurgical techniques for reversal procedures. I sent him an email.

I don’t understand how the neuro-blockade option offered at the Pur clinic would have benefit in my case. Do you have any insight there? They wanted $200 for a phone consultation.

Again THANKS to all of you for your input. It is much appreciated!


They didn’t test it during the procedure. the mass fluid that came out when they cut the vas was sperm but it wasnt tested for fertility at the time. Dr fenig made sure to finish the open ended procedure to make sure sperm didnt find its way back through to the other side to make me fertile again as that is not my goal at all in this (i got the procedure for a reason in the first place). Ive been tested since and passed so i am still sterile.

Were you talking about considering the denervation/ nerve block test? I had the nerve block done on 2 separate occasions to test to see if i would benefit from the denervation procedure. Due to the source of my pain and pressure, it didnt help much. I think its more beneficial for guys who have pain from nerve issues versus backpressure/blowout issues. Plus that needle is a bitch on those nerve blocks. It doesnt sound like denervation would be your fix, but you never know. I decided to get all the tests i could before choosing a path forward.


I’m not looking to have my nerves blocked. The obvious problem is the blowouts and the cyst that forms.I have discomfort only when this happens. I think I’m going to look into the open conversion. What a pain in my b***s this has been. :confused:

How common is the open ended technique? I read that some docs do this as a normal practice when first performing the vasectomy to avoid the problem we are complaining about.


I also found info on a number of doctors who regularly use the open ended
technique to avoid complications, but it is very far from the norm. I
wonder if it has to do w the fact that the closed ended non-scalpel
technique is easier and has less of a recovery time that it is the norm.
Also, I can’t ignore the fact that my right side closed ended is pain free
and great, so if both stayed that way (like most people), I wouldn’t even
be discussing open ended vasectomies on this forum.

That being said, since i was one of the unlucky few to have pain arise, the
open ended conversion has helped alleviate the nagging pain. Problem is
that there are so many different symptoms listed on this forum and no nice
easy single fix…do all your research because if you aren’t well versed
and informed, your doctor wont have all of the tools they need to help
resolve the problem.


Hi Scott , I came across your story whilst searching for a solution to my right sided testicular pain , and was overwhelmed with your story . To date I have had cipro several times over the past two years for 6 weeks at a time , slight improvement however the pain returns again and again . Cystoscopy performed everything normal ,
today I am preparing for further visit to the GP for another referral to the urologist , this open ended technique sounds it will resolve the problem and its the less invasive . Quick question are you still pain Free since the procedure ???
this condition has been wrecking my life for the past two years , all I want to do is put an end to the problem , the vasectomy whilst I felt it was the right decision at the time as been the biggest regret I have had in my life hope to speak soon gary


Hi basher, Sorry for the very late response. Its been a long time since i logged in to the pvps site. So far im still pain free after the open ended conversion. I had a minor flare up for a week or two back in january of this year but it cleared up. My urologist predicted that it was unrelated, but put me on that aweful cipro just to push back against the inflamation. As with last time, i could only tolerate it for a few days. I eventually took fenugreek and fennel capsules for those 2 weeks (after reading that they could help w inflamation). Not sure if it had a relation or not. Either way it appeared my urologist was correct that the pain was unrelated and went away quickly. Still doing well…the open ended conversion was great for me but as i stated before everones case is different. If its pressure, it may help. Good luck.


Hi Scott thanks for your reply , since speaking with you I underwent a reversal on the right side only . In terms of discomfort I still get a little intermittently but over the weeks it appears to be becoming less . Not sure whether I’m fertile again as I still need to take th sample in . Insurance wouldn’t pay so had to pay private , had it done under a spinal as afraid of ga . No pain felt whatsoever throughout the procedure however a little discomfort later that evening which subsided with naproxen .

I encourage everyone now who is thinking of having a vesectomy not yo do it however the technique I believe is different now to when I had it done 14 years prior , it may prove a different outcome with post testicle pain .

Moving forward it was one of my biggest regrets in life however you can’t go back what’s done is done and I do believe I will always have a little discomfort there as there is scar tissues etc

Please I urge everyone to really think about a vesectomy mine was fine for years then the problems started after 12 years ,

Good luck


If you had a little discomfort after reversal that is amazing. My reversal was a major junk adjustment for me. I like you had my pain subside with time after my reversal. When did you get your reversal and with whom?


Hi Mike

January this year at west midlands hospital Halesowen uk

The urologist mr Paul Anderson check him out on embarrassing bodies on the net great guy



I’ve heard of him. That’s great you are feeling better. My pain onset was slow but steady from year 1 to 5 and by the end I was pretty much disabled. I can’t believe I paid for the privilege of having a significant portion of my life ruined. I just wanted to ping you because I think there are a lot of guys that fix themselves and we don’t hear much from them. It helps the other guys here knowing some get completely better. I think once you are “better” or at least feel “better” you just don’t want to be here anymore. You just mentally need to separate yourself from this place and you know that’s okay. Again, nice for folks to see guys taking action and getting better.


Hi Mike,

You are correct about that…I know it was the same thing in my case as i spent many hours a week searching the internet for a cure and once i got better, i needed separation. That being said, I try not to forget what an all consuming issue pvps can be. In the case someone has similar symptoms to mine, hopefully I can hep at least one person with my story. All the best.


@basher you had your vas done 12 years ago. At what age? Also how active where you excerise wise and sexually ( like X time month or year )? Also curious as to when you had your reversal what they thought was causing you issues. Thx