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Pain started about 2 years after open-ended vasectomy


#22

Yes, yes, and yes. Your urologist has two things working against him. #1 he is a physician. #2 he is a urologist. This is not to dis doctors. However, they just don’t know how to think outside the box (aka textbook). I’m not sure if it’s the fear of lawsuit or shear arrogance getting in the way of being open minded but medical professionals are no longer diagnosticians. They order tests and let the blood work make the guess for them. It’s very unfortunate. Urology is mostly a procedure based specialty. They know how to cut but understand little about the physiology.

Papaya is somewhat controversial. If it was a marketable patent, trust me, it would’ve been a drug decades ago. I don’t know why physicians aren’t willing to look at alternative methods. See below…

“Carica papaya seed extract may selectively act on the developing germ cells, possibly mediated via Sertoli cells, leading to azoospermia (sterility).” ~Asian Journal of Urology 2002.

“Arrested spermatogenesis was observed in the seminiferous tubules of all [papaya seed] treated groups…and [they] recover normal sperm characteristics when the extract is withdrawn.” ~Animal Reproductive Sciences 2011.

It WORKS. You can’t argue that. There’s too much literature and it’s not your fault that he refuses to keep up on the research.

The affect of papaya on granulomas is only my theory. I have granulomas but they are minimal and not painful. Granulomas form as an immune reaction to a foreign body or toxin. If you get a rock or sliver in your hand, a granuloma will form around it as your body attempts to rid of it. My professional training is teeth. Granulomas are extremely common in dentistry and they are the main force behind toothaches. When a tooth dies, the necrotic tissues release toxins out the end of the tooth. The body responds with a granuloma at the base of the root. As this granuloma expands it becomes painful because it is surrounded by bone and the pressure increases. Removing the dead tissue from within the tooth, sterilizing and sealing it causes the granuloma to dissipate and the pain to disappear. This is essentially what a root canal is. The body’s response via granuloma isn’t towards the tooth but the crap coming out of it now that the nerve has died. To me, it makes sense that if you can remove the irritant leaking out of the vas deferens, the granuloma will go away as well.


#23

Pretty sure that’s what happened in my case. I had pea-sized granulomas at the end of the testicle-side vas tips. I had sprung leaks. Post-reversal, I feel no granulomas anywhere.


#24

@raising4girls

To this same point, why is the granulomas always on the testicular end of the vas deferens and not the other end? Think about it. Sperm.


#25

@Choohooo, @raising4girls Thanks guys for the replies. The granuloma I have is at the base of my epididymis from blowout, instead of the cut end of the vas. But the same principle applies, and it is still the testicle side. Doctors have told me that granulomas can shrink, so if they believe that, then it seems reasonable to me that they could also disappear completely.

Looking at the Asian Journal of Urology study, they used dosage of 50mg/kg/day. So with my body weight, and translating mg to teaspoons, that would be a bit less than 1 teaspoon a day of papaya seed. So looks like 1 tsp. per day is in the right ballpark.

Also, I remember seeing a case report that recommended Testoserone had good results for granuloma pain, so would be same principle of shutting down sperm production:

The use of testosterone in the treatment of chronic postvasectomy pain syndrome: case report and review of the literature.
The use of intramuscular testosterone cypionate in a dose of 400 mg monthly for 3 months is described for patients suffering from painful sperm granuloma at the vasectomy site or in the epididymis, circumventing the need for other medical or surgical approaches. Excellent results have been achieved in patients and a representative case is illustrated.


#26

This is not a fix but i have said this many times on forum and new people join all the time so will say again. Open ended vas which i had to is nust another way to sell their bullshit product. If anything its worse leaking sperm in body.i suffered ectreme pain from start. If you going to get cut for granuloma just get a reversal i did.


#27

“if it worked then we’d all be taking papaya seed for contraception”.

What immediately came to my mind, is that contraception requires the ability to block virtually all sperm. We only need enough reduction to stop our symptoms. So it can be both a lousy contraceptive and a good treatment.


#28

As an update I am 1 month on the papaya seed and seemed to slowly be trending a bit better the last week. But had sex in the afternoon yesterday and while it didn’t hurt at the time, right afterward the soreness and burning increased alot in my left epi. Even this morning it hurts more than it had been. So it is confirmation to me that my pain is congestion related (and granuloma doesn’t help either).


#29

Hi guys, a quick update. I’ve been trending better and wanted to share something that has helped me. Main issue for me is inflammation (caused by epidymal blowout), but since NSAID’s give me stomach ache, I have been taking Tumeric and Wobenzyme. The Wobenzyme in particular seems to really help inflammation for me, as good or better than Advil/Aleve.

As I understand Wobenzyme has been around for years and there have been a few studies on it that I’ve seen, including this one: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4329848/

For me, it took about a week for me of taking it regularly before I felt a difference. I did 3 pills twice a day which is what it says on the bottle. You have to take it on an empty stomach (in between meals) otherwise it won’t have as much effect. I noticed that when I ran out of them, I started to feel worse within a day or two. When I got more in from Amazon, I started to feel better again quickly.

Here’s the one I am taking: https://www.amazon.com/Garden-Life-Joint-Support-Supplement/dp/B0015G4XD8?th=1

I haven’t noticed any side effects or issues at all, other than I got maybe 3 minor nosebleeds in the past month. I read that Wobenzyme can thin the blood so something to be aware of if you are on blood thinning medication.


#30

Hi guys, quick question: Has anyone had surgery to remove a granuloma from the epidiymis (not from the vas deferens)? If so, was that granuloma removal done as part of a reversal? It seems most guys here get granulomas removed from the vasectomy site (vas deferens), as part of reversal. But I haven’t heard of reversal surgeons removing granulomas further upstream in the epididymis?

The 1.6cm granuloma they saw on ultrasound is at bottom of my left epidiymis from blowout. Doc said he could remove the granuloma, but he’d have to take a section of the left epi as well. I wonder if a more skilled doctor could remove just the granuloma. I’d be hesitant in removing even a small part of the epi because I wonder if that would cause more problems or prevent reversal success if I needed that in future.

I’ve been on Papaya seed for 2 months now, and planning to stay on it for entire 3 months before deciding on next steps.

I think most of my soreness and left leg sensations are from the granuloma pushing on things. It usually gets worse as the day goes on, and sex definitely stirs it up.

I had a bit of a setback for last couple weeks. It started about the time I was working a lot in the yard, shoveling mulch for my kids new play set. Also doing some lifting to help install a new counter top. I also ran out of the Curamin (tumeric) I was taking. I started back on the Curamin (along with the Wobenzyme).


#31

Ok, not hearing a reply so I take it that no one on the forum has had a granuloma removed from their epi.

In about 2 weeks I will have been on Papaya seed for 3 months. I am not (at least yet) seeing the improvement of symptoms that I thought I would see.

Any advice on next steps to consider? If I decide on surgery, would it be better to just remove the granuloma from my epi? or to go ahead with a full reversal and have them remove the granuloma from my epi at that time?

Thanks


#32

I think it would be worth talking to a reversal specialist for a couple reasons. Everytime you reoperate on a previous surgical site, you increase your risk for complications. Also, any operation on your epi could affect a potential reversal in the future.


#33

Thanks @Kyvas for the input. I was thinking along those lines as well. Also, I would be concerned that granuloma would just form again a few years later, even if it was removed.


#34

I spoke with Dr. P. today about next steps:

  • His next recommendation was an oxytocin / cialis combo “happy pill”, that improves blood flow to area and he said seems to help pain.

Has anyone had experience with the “happy pill” combo? Did it help / hurt / no change?

I don’t have any problems with erections, and sex makes my pain worse (delayed, and lasts for next day or two). My pain is usually a 2-3. Usually a 1 when I first wake up in morning, and exertion and sex makes it hurt more, up to 4.

I generally dislike medications if they are just masking the problem and not really helping, especially with possible side effects. (I keep thinking of that erectile dysfunction TV ad… “if you experience an erection lasting longer than a few hours, seek medical help immediately”. =)


#35

Speak to the reversal surgeon mate, don’t let it get out of hand.


#36

Hi @SomeGreyBIoke, I also talked to Dr. P today about testosterone therapy and reversal. Here are my notes (in my own words of course):

  • Testoserone therapy is a major shift in therapy and most risky, since my natural Testoserone levels may not come back after the therapy. That would cause more problems since I’d have to be on T replacement for life, and still may have pain. So he would not recommend that.
  • Reversal is a good option and he was positive about that. He said most guys do not regret getting a reversal. There is also the psychological benefit as well to being “put back together again” that some men feel.
  • Reversal usually resolves or significantly minimizes the pain. For some with persistent pain he may do a denervation.
  • He said that most of the reversals close up within 2-3 years, but the pain doesn’t come back. So as I understood, it is helpful just to get fluid flowing again and relieving pressure on epididymis, and fertility and sperm is not directly tied to pain relief.
  • For pain, he would do vas to vas reversal only. In his experience, Vas to epi reversal is not recommended for pain, since it may cause testicle to sit higher and cause even more pain pulling on the sensitive epidymal area.
  • He said don’t worry about the granuloma in the testicle, and ultrasounds are useless compared to what they see at the time of surgery. Granulaoma sits several layers inside epididymis. Most guys have granulomas and even blowouts with vasectomy but have no pain.
  • As I understood, main thing is to remove the granuloma, suture, scar tissue around vasectomy site, which all can be exciting the nerves down near the epididymis.
  • Epidymis has alot of nerves that converge there - not good to remove it or mess with it as it may cause more problems.

#37

I talked to Dr. Burrows today about reversal and here are my notes (in my own words of course):

  • Sounds like congestion of sperm
  • He suggested trying conservative therapy (testosterone, steroids, cord block) for 3-6 months to see if improves, and waiting that long will not impact my odds of reversal success
  • He would not recommend removal of epi, causes upstream pain
  • He has done about 4000 reversals - about 10% of those for pain
  • Vas/vas or vas/epi re-connection depends on what they see at time of surgery (if they see sperm or not).
  • He said that 2 years out, it is very rare to need vas/epi (no matter what they see on the ultrasound).
  • In either case (vas/vas or vas/epi), he would remove an epidymal granuloma (inflammatory reaction to sperm) during the reversal. That removal during the reversal would not impact reversal success.
  • If I remember right, he said a 2% closure rate for vas/vas vs. 10% for vas/epi
  • He would do a 1" incision on either side of scrotum so that he doesn’t have to drag tubes over from the middle, since the epi and tubes are located on either side
  • He does not usually do drain plugs on initial reversal, more for redo reversals
  • He would recommend to stay a couple days at the hotel, and he would come to hotel and check on me the next day. They follow up with sperm checks

#38

I wasn’t expecting such opposite views from these two respected doctors – one would only do vas/vas and would not touch a granuloma in epi, and the other would do a vas/epi if needed and would definitely remove a granuloma in epi.

To me, it seems Dr. P is focused more on nerves to resolve PVPS, and Dr. Burrows is focused more on flow of sperm to resolve PVPS.


#39

Odd thing about closure rates, Dr P says they all close up, whereas Dr B says 2% closure


#40

@worship01 I have consulted with Burrows twice and P several times. Both are very knowledgeable and helpful to answer questions and options. I respect both opinions. I have some nerve issues as well as minor congestion and both Dr’s gave me options and both considered a reversal a good step after time and conservative approach. I have also consulted two PVP fellowship trained surgeons local to my area that gave their opinions The one thing that stands out is no two are aligned with recommendations and all have different options success rates etc. At the end of the day you have to do your own research and come up with the best plan for yourself. A lot of guys say go with your gut.


#41

@SomeGreyBIoke Thanks for the comment. I think Dr. B. meant that it is a 2% closure chance per year for vas/vas.