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Please ask questions before Denervation


#1

I would ask any potential person to ask many questions before having spermatic cord denervation. Especially regarding stats that make this look like a better treatment then is stated. Almost everyone will likely feel better following this treatment, however as I wasn’t aware, the nerves grow back and can be really pissed off. Any surveys regarding SCD needs to be done 1-2 years after to provide true results. My survey would have been really good at the 3 month mark and then awful from the 6 month mark onwards. This surgery really has virtually made me a cripple when it come to any sort of manual work/sex life - I just can’t do it without a great deal of pain afterwards.

I think Dr’s need to hear this and understand and warn patients that it can actually make you worse. I have raised my concerns with the dr who did my SCD whom I really like, and others need to as well. Just like vasectomy, although the stats look good and it can be a great outcome, there is also a downside which isn’t talked about as much. Please just make sure you get solid answers from the doctor that your condition is suitable for SCD.

This surgery seemed logical to me, as if you cut the nerves transmitting the signals from a painful area, your brain won’t detect them. The only problem with this is that your body tries to heal itself and the nerves will grow back. Now you have had a another surgery with more damage which your nerves will likely not like. In my opinion if you are having pain in your vas defenens following a vasectomy, this is not the surgery for you. If you are having pain in your testicles then it may be an option but make sure you get good answers from your surgeon before you hurt yourself even more.


#2

Are you worse today compared to post-vasectomy, pre-SCD? Do you think SCD would be a good choice if the pain is coming from the cord?


#3

Thanks for posting this @changeneeded. This is the type of information we need on this site. It’s what makes it an invaluable resource. There are few surgical options for treating PVPS. The more information we present about all the options the better choices men can make.

The options are here:

  1. Reversal
  2. Vas Redo/Cleanup (or some variation, i.e. conversion to open ended)
  3. Epididymectomy
  4. Spermatic Cord Denervation (SCD)
  5. Orchiectomy

#4

I spoke with a surgeon (non-urologist) who expressed concerns about SCD because of the potential for nerves to re-grow or form neuromas. I think that’s exactly what the OP is stating happened to him, sadly.


#5

I thinking I’d add neurectomy to this list (in part, hoping it may work for me). Seems as if those at the Dellon Institute have treated PVPS and scrotal pain sufferers with neurectomy, but since they’re not urologists, they don’t get the press that these other 5 get.


#6

I’m not certain but I thought with the type of neurectomies Dellon does they make a point to bury the upper portion of the nerve branch into muscle so it can’t regrow. Correct me if I’m wrong but I do believe the types of neurectomies for hernia pain patients are all done in that way. Proper placement of the severed end of the nerve is important in preventing recurrence of pain.


#7

Hi Sen, my pain is definitely worse after this procedure. I had pain following my vasectomy, which after 2 years was mainly after sex. Now I am in chronic pain and have a much higher degree of pain after sex or manual work since SCD.

It’s amazing when you have pain after a vasectomy how desperate you are to try to get back to normal. I was willing to try anything and again I opted for a quick fix when I really should have asked more questions and waited longer to see if things would have gotten better on there own. Also the 85% success rate that is posted with this procedure is very enticing (again in my opinion this stat was likely taken 3 months after the surgery rather then 1 year or more). I really just don’t want others to go through what I have and be in even more pain…my life really sucks and don’t wish it upon others.


#8

I think that you should avoid this surgery if pain is coming from the cord. To me it made perfect sense to have this surgery from my cord pain…cut the nerves that are going there and ta-daa…pain will be gone. But if/when the nerves grow back…look out because now your cord is really inflamed and the pain threshold is much lower.


#9

Yes, that’s how Acschiro explained it and how the surgeon also explained it to me. The surgeon explained that’s one of the most important aspects of nerve surgeries, to prevent re-growth or damage or neuroma. It makes sense to me. Also, in the case of SCD, they’re going in among the weeds and hoping they find the culprit branch nerves (from what I understand). Dr. P. has apparently identified via research the likely culprits. But, as others have stated on this forum, it seems like SCD is trying to take down a tree by removing branches instead of taking it down at the base of the trunk. Could be a crude analogy, but it makes sense to me.


#10

Just from experience I know guys will be so desperate to find a solution to their PVPS as quick as possible. I know it sucks beyond words, but I would say to anyone you need to be patient and see how much your body will heal on it’s own. The only surgery I would recommend is reversal (which I had but didn’t help but didn’t worsen) - at least it is trying to put your body back to what it was before the vasectomy.

As Mike listed their are other options but I know little about success rates and such so don’t have any suggestions for these either way.

I think SCD needs be done in a different way to ensure nerves don’t grow back or researchers need to come up with a better method. Patients who are in pain need assurance that the treatment they seek is not going to make them worse. I mean we are talking about guys balls here, you think it would be in every guys best interest that we had doctors and researchers doing everything possible to find a perfect solution :slight_smile:


#11

What do you plan to do about your PVPS? Have you considered orchiectomy? I had a reversal, it hasn’t produced the results I wanted, now it looks like the next step for me is SCD, then orchiectomy. I don’t know what else to do. I’m out of options. Do you plan just to live like you are now? I can’t sit by and do nothing.


#12

I don’t have much pain in my testicles so no, I will not consider orchiectomy. Where about’s is your pain exactly?

I plan on waiting till a GOOD pvps treatment comes out so I may be waiting a long time. My next step is to try medicinal marjuana to see if that helps.


#13

I believe it’s the cord. I’m 13 months post-reversal. It’s helped a little, but I’m not happy with the results. I have an appointment with urologist on Nov 1. I guess I’m the opposite of you. I’ve waited long enough, and I don’t want to wait more.


#14

Is your pain both sides?


#15

No, unilateral, left side.


#16

Guys, I really appreciate everyone’s consult against SCD. The results simply aren’t there. I had a reversal in 2006 and, other than a 6-month relapse in 2008-09, I was pain-free until April 2016. This relapse has lasted 18 months with no end in sight. Same pattern, same problem, most likely degeneration or fibrosis of the nerves in the scrotum. Challenge is finding out which nerves since the scrotum is innervated by several.

I’m having pulsed RF ablation of the left GF nerve on 10/31. My pain is primarily, if not entirely, left sided. If this doesn’t work, Pain Management has suggested a block of the Superior Hypogastric Plexus. I didn’t know this, but it starts at L5/S1 and I had fusion at that spine level in 2012. Could be related. Right now, though, the feeling is that the GF is the problem.

I had a phone consult with a peripheral nerve surgeon in Baltimore last week. He claims to have helped men with scrotal pain via neurectomy.

I mention these treatments here in hopes of giving you all some options and hope. Hell, I don’t know if any of these will work but I feel like I’m trying.


#17

Ok that is better then bilateral. I would specifically ask the dr then if he has patients that have gotten better with your exact symptoms (and also if any have gotten worse). Hopefully he is honest and gives you a true answer.


#18

The more I read here and the more I speak to forum members offline, the more I think the Urologists aren’t able to help many of us. Certainly, denervation SEEMS like a good, less-invasive option than orchiectomy. It makes theoretical sense, but it doesn’t seem to yield durable results for PVPS guys. Maybe some, but we need a predictor of outcome especially since some seem to be made worse from denervation.

I spoke with a peripheral nerve surgeon who expressed that the Urologists are missing the risk of re-growth or neuroma with SCD. He removes the nerve(s) higher up in the groin and avoids messing with the spider web or nerves in the scrotum. He then protects the nerve ending in the muscle to prevent neuroma growth. It’s still risky, of course, but seems like a better option (for me, at least) than SCD from a urologist.

To all men here that have gone through reversal (like me) and are still in pain or having setbacks, I think urologists pretty much only have one more bullet to fire, SCD, and its results are a mixed bag.

For that reason, I sincerely appreciate all the guys’ who’ve gone through denervation and have made efforts to educate us on the real risks, not the 85% success rates they claim. In truth, I was ready to jump into SCD several months ago. Now, I’m focusing on efforts with Pain Management and with a peripheral nerve surgeon. If those two avenues fail and I’m still in pain, then and only then would I consider SCD.


#19

I find it interesting that you were quoted an 85% chance success rate with neurolysis, and another member recently posted he was given a 90% chance success rate for the identical procedure.

The person that did your procedure (85%) is the one that pioneered / invented that procedure. That’s not a bombshell, it’s posted in another thread here. I’ve always heard the success rate was approximately 85% from the pioneer himself.

The person that did the other guys procedure (90%) was done by a completely different entity, in another state. He was never warned neurolysis had any chance to make him worse either.

So, assuming everything that has been posted at this site in regard to neurolysis is true, we already have different success rates being quoted with such a relatively new procedure.

Far as I know, several thousand “neurolysis” procedures have been performed by now. I can remember when only several hundred had been done.

Obviously, and assumingly, neurolysis is being performed elsewhere to.


#20

It’s the posts like these that will keep me from doing anything surgically until I can’t take the pain anymore. My life is a good deal harder post vas, but I can live with my pain currently. I couldn’t imagine having more pain and I am sorry for those of you that do. Hopefully you can find an answer.