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Post Vasectomy Pain Forum

Pain started about 2 years after open-ended vasectomy


#62

I just got back from visiting a local urologist (Dr. Douglas). He is in the same practice as the other urologist Dr. Matthews whom I first visited about 10 months ago. Dr. Douglas is the only one there who does vasectomy reversals, and the only reversal doctor in my immediate area that I can tell. Here are my notes:

  • He examined my testicles. Right side was fine. By feeling around he found the granuloma very quickly on my left side. He said it was at the base of my left epididymis, so that confirmed what the first doctor had told me 10 months ago.

  • He said the granuloma didn’t feel that big, and was not 1.6cm across like the other doctor said. He said he has felt larger granulomas on guys who have no pain at all.

  • He also located the site of my vasectomy, and he said it was not too close to my testicles. He said it was at a pretty standard position about 1" or so from my testicles.

  • He said he didn’t like open ended vasectomies because they all close up / scar over within a few weeks anyways and carry potential for painful granuloma at vasectomy site. As a side note he said of one guy whose open ended vas adhered to the skin and every time he ejaculated some sperm would drip out on his skin… that is one was to do it. lol

  • He usually does just a small incision for reversals, but in my case he’d take the left testicle out to examine it and see if granuloma was accessible and could be easily removed. If not, he would likely leave the granuloma in there since he wouldn’t want to jeopardize the reversal. He said epi is delicate and trying to remove granuloma could impact blood flow to it and he would then have to take out the whole epi.

  • So he would do a vas-vas connection and hopefully the pain would go away (if it was due to congestion). He said it was not likely the granuloma would go away on its own, but that if my pain was due to congestion then reversal would resolve the pain even if granuloma is still there.

  • He said vas-epi connections are not as good, due to mismatch in sizes of the tubes and paper thin walls of epi. He said you can see the tubules of epi through the walls of epi. I didn’t ask him outright if he does bypasses, but it sounded like he was most comfortable with standard vas-vas.

  • He said insurance would cover removal of granuloma, but likely not cover the vasectomy reversal. They definitely would not cover vasectomy reversal for fertility, but for pain he said they might cover a reversal.

  • He said about 99% of reversals he does are for fertility, and he only does ones for pain every couple years.

  • Reversal cost would be about $7,000 total ($2,500 surgical feee, $3,500 for hospital fee, and $1,000 for anesthesia).

  • He said another ultrasound isn’t needed.

  • He said to let me know if I want to move ahead with reversal. He said odds are 75% it would get rid of the pain.


#63

So my thoughts on what likely happened…

My open-ended vasectomy likely closed up and ultimately the backpressure caused blowout in tail of my left epi. My right testicle/epi is larger so perhaps was able to handle the congestion better.

So obviosuly I must have had some congestion of sperm for it to cause a blowout, but my gut feeling is that congestion is not the main cause of my pain. My feeling is that the granuloma is causing the pain, probably like this snippet below says.


image
(taken from: Testicular Pain Following Vasectomy: A Review of Postvasectomy Pain Syndrome)


At this point I think precision surgery to remove the granuloma and reverse the vasectomy at same time would be next logical step. My feeling is that an experienced reversal surgeon with operating microscope would do a better job of removing the granuloma without damaging the epi than a general urologist could do. Also, the reversal surgeon would also have interest to keep the epi intact so that reversal could be accomplished. I would want to make sure that they would remove the granuloma first before checking for sperm in the vas, in case granuloma was blocking the vas (not sure if that is possible, but makes logical sense to me).


#64

Another thing I just thought of. About 6 months before I starting noticing pain problems my wife and I started taking Maca root to increase energy / vitality, etc.

But I just read studies that it can also increase sperm count. That may have been a contributing factor to me having a blowout on one of the side. So please everyone avoid Maca if you have a vasectomy…

image


#65

I just spoke with Dr. Russell in Ohio on vasectomy reversal for about 20 mins. Very pleasant guy to talk to. My notes (in my own words of course):

  • He asked some general questions about when my vas was done, what kind of pain I had, etc.
  • He asked about my fertility before the vas, how many kids and goals for the reversal (pain only or pain and fertility)
  • He mentioned the different surgical alternatives (reversal, removal of epi, scd). He mentioned that epi removal carries risks since epi is where the nerves and blood supply go into testicle, so potential to damage blood flow to testicle.
  • He said that pain spikes with sex are highly indicative of congestion. And that in cases of congestion that reversal had a 80-85% success rate to eliminate or greatly reduce the pain.
  • He said that nerve related pain usually manifests all the time, so reversal had only 50% success of curing the pain there.
  • He said that it was 90% chance of not having to do a bypass since I was only 3 years out
  • He mentioned if i was on testoserone then it could impact sperm, so would need to stop prior to reversal. I told him no, but I mentioned papaya seed I had been taking and that I’d read it had reduced sperm in animal studies. He didn’t seem familiar with papaya seed, but didn’t completely discount it either. He said that testoserone would likely do better job of reducing sperm.
  • For pain patients he would try to remove any scars/granulomas he can see or feel. For fertility patients he would not unless they were in the way of the re-connection.
  • I asked about blowouts and granulomas, and to my surpise he said blowouts do not cause granlomas, they cause blockages in the small tubes internal to the epi as I understood. He said blowouts don’t typically cause pain since the tubes are so small in the epi.
  • He said he has not seen one granuloma on the epididymis in the 14 years he has been doing reversals (~4 a week). He said most likely it is just leaking from cut end of vas.
  • Follow up seems important to him. He would do sperm test at 6 weeks, and then every 10 weeks. He would prescribe prednisone / aleve if needed to reduce inflammation and prevent premature scaring up of the reversal. Some pain patients do not want sperm checking once they are pain free and he would respect that as well.