@Darcy, I’m at a bit of a loss for answers myself.
It’s said that pvps can get going from the beginning, to out 20+ years.
It doesn’t seem you mentioned your age, but my guess is, if this does have something to do with your vasectomy, it’s neuropathic, and not congestive in nature.
You’ve had many tests and such done, but tests and such aren’t going to show pvps.
Again, I’m at a loss far as what to say, or advise other than get an in person, or telephone consultation with an experienced pvps doctor.
Personally, I tend to think that most cases of pvps that start up years down the line are neuropathic in nature, and not congestive. From scarring, organ damage, nerve damage, other not so well understood conditions, etc.
I’m sure congestive pains can, and do start years down the road for some, but my guess is that it’s not common.
If this is related to a hiking incident, I would again guess neuropathic in nature.
Personally, I think cases like your are even harder to troubleshoot than cases that get going within the first year~.
Perhaps this has nothing to do with the vasectomy, but odds are pretty good that it does. Hard to say one way or another.
Again, get in touch with an experienced pvps expert via tele, Skype, or in person.