Quick question. Should i even consider reaching out to the Pur clinic for a consult since I have zero desire to do denervation? I know thats their go to procedure and im sure they will probably sell denervation. I have no doubt Pur clinic is probably the best when it comes to pvp but with their emphases on denervation I wonder if its even worth me reaching out.
i have basically the same question.
I’ll take a crack at this. I think there’s a reason no one is responding. I think people are afraid of giving honest opinions. There can be repercussions for these opinions s especially since PVPS’rs have become a strange tight knit group. PUR is a big player in PVPS but don’t expect them to be the answer from above.
PUR sees a lot of PVPS. A lot. However, when it comes to this stuff, your options are very limited. I’ll go out on a limb and say not even PUR is exactly sure how to fix you. They offer denervation but there are others more experienced in the practice. They offer reversal but there are others more experienced in the practice. They offer several treatment modalities, they’re certainly sympathetic about your pain, but they roll the dice (or in this case your nuts) and hope you feel better when you wake up.
I’m three years deep into this mess and I’m confident to say, you will find more knowledge on this forum than you will anywhere else in the world. So called experts are just that. There isn’t a magic fix. Most guys worsen or eventually relapse from denervation, reversal helps a handful of people, PT helps, meds help.
There’s no one man or one procedure that is going to fix this. I consulted with PUR five times and it was five treatment options each time. Fortunately Dr P is a realistic physician. If you’re not ready to shoot you’re self because you’re in so much pain, I would shy aware from more surgery. Dr P agrees. However, he’s a surgeon. He cuts for a living.
I’m not sure if I answered your questions or not. I don’t want to be a pessimist but I think it’s important to understand early on that there isn’t a magic fix. Consultations and advice coming from the members on this forum are better and cheaper than you’ll find anywhere in the world.
I reached out to Dr Marks at about 8 months, and of course he recommends reversal. He gave me the names of a number of other urologists including Dr P for a second opinion. He said Dr P tends to favor denervation.
However, when I spoke with Dr P, he recommended reversal based on my symptoms. He said that in my case denervation could be a second line treatment. Reversal has helped a lot so far, I am 5 months post reversal with Dr P. I would say I am 90% better with only occasional niggles, rather than nuisance pain - before I had kicked in the nuts and defecate from scrotum pressure feelings. I’m happy with the outcome so far.
I have a good friend who is an anesthesiologist, and he talked to a number of specialists in pain management on my behalf. He said that the processes Dr P uses to prevent pain are consistent with the most modern pain management techniques of preventing post-surgical pain, and that gave me a lot of comfort.
My first SA was pretty low - very few sperm and all dead. I have another check in next week, we’ll see how it progressed.
typo, meant to say denervation. fixed in the post.
Hey Robert. Im very happy you are recovering! I had a revrsal with Dr Marks. While i dont regret it and i couldnt have been happier with his care i am still in pain. My options are becoming more limited as i am now faced with destructive surgery to remove pain. Im gonna wait as long as possible but we shall see. Thanks!
I have great deal of respect for the pain mgt. and urologists who attempt to treat men with chronic scrotal pain, be it from vasectomy like us or other. I cannot think of a worse ailment, and I had L5/S1 fusion which was no picnic. Because of this, I can’t say anything bad about the various doctors mentioned on this forum. Hey, at least they acknowledge us and are trying to help. To me, that puts the PUR Clinic and others like them (Dr. Marks, Dr. Shoskes, etc.) in a class well above the urologists who are vasectomy pain deniers.
I don’t think any consult is a waste of time. I will also say that the PUR Clinic has not at all pushed denervation on me, just made me aware that it’s available and likely a better surgical route (of what they offer) compared with a re-do reversal. Can’t argue that, should I go down the surgery route, because I don’t think congestion is at the root of my problems. The question is whether denervation or anything else will solve this neuropathic pain. Like Choohoo said above, it’s a roll of the dice.
I don’t think any of the surgeons really know the odds of their surgeries being able to help us.
No doubt it is worth a consult. I had a reversal with Dr P after consulting with him for over a year between the merits of denervation or reversal. It was very helpful to hear his thoughts and ideas and that enabled me to make the decision that I thought was best for me. At the end of the day - YOU have to decide how you want to try and “fix” the problem. I feel like Dr P gets that and I felt the freedom to do either of the surgeries or to do nothing.
Right. I have nothing against the Pur clinic im just wondering if they would have any other treatments post reversal other than denervation. Personally i would get bilateral orchiectomy before denervation so theres no way i would want that based on testimonies from this site about genitofemoral neuralgia rsd etc. Ive thrown ALOT of money at this “risk free” surgery so far and Im not about to waste more on a consult if denervation is the main thing being sold.
Fair points. If you know what they’re going to say, then why bother unless you’d contemplate making the PUR your go-to for treatment.
I’ve heard the statement a couple times that men who choose orchiectomy (sp?) over denervation. I don’t understand that perspective but will ask one of the uro’s sometime. I’m not dismissing the risks of denervation, but it seems to me there’s even more cutting with orchiectomy. I see more risk in the latter, but, again, I don’t know a lot about either. Don’t mean to hijack the thread with that question either.
Yeah its a tough decision either way. Im not excites about either but from the info gleaned from this site which is the greatest pvp resource that exists It seems that denervation is more risky. But thats just my personal take away.
Also, i dont know what they are going to say thats why I asked. I have a supposition based on their website and their posts on this site but i raise the question to hear the men who have had experience with Pur give their perspective. Im not trying to win any arguments for or against anything. Just trying to use the brothers on this site to help me think through this.
Sorry, didn’t mean to come across negatively. I meant from the standpoint of saving you $200.
In reality, this forum is probably worth more than what the uro’s charge us. Guys like Choohoo and Acschiro are medically trained and have done more research on our condition than 99% of the medical community.
BTW I totally respect anyone who’s cautious or suspicious of denervation. I feel the same way right now. But, while we all have similar and related maladies, each of us also has a unique situation. I’ve joked that I have something of a “lite” version of PVPS because it’s gone into remission twice for a 2-year and a 7-year totally pain-free existence. My periods with pain combined are just now approaching 3 years (15 months this bout). So, I’m thinking I have less nerve damage than some who have had pain from day 1. For that reason, I DO wonder if I’m a better candidate for denervation, but, again, seeing the results here has me more worried that I could make matters worse.
Something I think we’d all benefit from is learning if there are different techniques for performing denervation. I’ve been treated by two uros (frequently mentioned on this forum) but never thought to determine if they use the same approach.
Anyway, sorry to come across negatively. Not intended.
This is one of the things that stinks about us guys. Honestly you have to figure out what to do. No doctor will tell you because they don’t really know.I only see three options, reversal, denervation, do nothing. I would reach out if I was considering reversal
There’s definitely at least two different versions of de-nervation. There’s the traditional version, and there’s the Dr P version.
To the best of my knowledge, Dr P version leaves far more of you intact. It’s unique, and I’ve heard it compared to a sniper rifle, vs, a shotgun on several occasions.
I’ve seen/heard him explain what he does, and what’s different about it many times, but I think he would do a much better job explaining the difference himself.
No worries. These are tough decisions.
I have a consult set up with Dr. P. for this evening.
Denervation isn’t even in the cards, so maybe this consult won’t be as helpful as I might need, but I do want to talk with someone who will take my concerns seriously and who has seen a lot lot more than my Urologist (who doesn’t seem to be that concerned) and has a larger sample size of experience to draw on.
I’m not even three months in yet, I had some pretty much pain free days last week that got me too hopeful, and then reality came crashing back down.
And I will probably consult with Dr. Marks as well before all is said and done.
Thats smart. I hope you get some good info. I would consult with them in a heartbeat as well but me being two corrective surgeries later being in the game for a while I feel like my options are more limited esp since I have no interest messing with my cord. Please keep us posted with what they say. Thanks!