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PVPS after reversal nerve pain?


#1

My story…(or should I say ongoing nightmare!)
I had a vasectomy 10 years ago. My urologist used “metal” clamps for the procedure.
Almost immediately I started having pain on both testicals. I would go through days of 8/10 pain then several days of 2/10 pain. I have been told by multiple urologists that my pain probably IS NOT vasectomy related! Can U believe that s@&$!
I swear that it’s a huge cover-up in the medical field to downplay anyone saying they are having pain after a vas.
Now fast forward 9 years. I have been to the E.R. 3 or 4 times been told I had epiditimitus or sperm granulomas. I have had “cord block” done to my spermatic cord (which worked for maybe 7 hours ).
Finally I paid (out-of-pocket) for a reversal this past February. Everything started out great but recently I have started having nerve type pain on left side vas where it was reconnected. Oh…and my doctor left the metal clamps in place! Said the benefit of removing them doesn’t outweigh the risk.
So now what to do?! Anyone else have nerve pain of spermatic cord? And if so what helps? Also, I strongly believe if the metal clamps were removed that would stop the pain. If I can just find a doctor in Atlanta to take them out !


#2

Who did your reversal? I’m not sure why he would leave the clamps in. He would have to sever the vas deferens above the clamp to get to viable vas anyway. I have pictures of the two ends removed with sutures from my reversal, however, I don’t have 4 which is what you would expect.

Welcome here. Lot’s of new guys lately. I am close to 10 years myself but I had to act at year 5 because I was essentially disabled at year 4 1/2. I could not work, too much pain. I would bet you have a lot of angry nerves around those metal clamps as well. If I was you I would find a micro-surgeon to take them out and not just some guy who will do it.

Please explain your symptoms and how they developed and what your issue is now.


#3

Hi. Welcome. That is half a job done why the hell would they leave clips in place? Thats stupid. Get them removed no easy fix more surgery. All the best to a good outcome.


#4

As far as the Doctor Who did the procedure he’s in the Midwest but I don’t want to release his name. He stated that he has taken clamps out a few times over the years but due to the area he just bypasses the clamp by cutting behind it and reattaching the vas. He said removing the clamps are not worth the risk(easy for him to say). Trust me, I constantly cuss myself for not telling him to take them out.
The pain that I had before the reversal is consistent with what most men are stating. Epididymis, sperm granulomas, fullness in one testicle or both. Then there is the nerve/burning pain located in the spermatic cord that starts at where the clamps are and it raidiates


#5

Continued…It radiates up the vas deferan.
Since the reversal all the problems are gone except for a nerve/burning pain in the vas area where clamps are.
I went to see a urologist/specialist in Atlanta last week and he was adamant that the clamps were not causing the pain!
I actually got a little upset with him and said I just want the clamps out! He stated “do 30 days of steroids and if that doesn’t help then we will go to testosterone therapy”. What kind of doctor do I need to see that will listen to me and just take the clamps out? Preferably in the Atlanta area


#6

My thought is maybe after 10 years, the clamps/scar tissue have adhered to the scrotal wall, testicles, etc and by leaving them alone there is less risk of hematoma, neuromas or other complications. That’s probably okay for a fertility reversal, but I’m surprised they weren’t removed for a pain reversal.


#7

I would ask Dr. P about removing them using microsurgery. He would probably do it. What are your SA numbers?


#8

I just thought I’d throw my hat in the ring here:

Dr. Jarvi in Toronto told me that he doesn’t generally remove the clips as he prefers to not disturb the vasal sheath any further.

I was kind of surprised at that, especially given the potential for nerves to be entrapped in scar tissue, etc. but he told me that his thinking was that if the vas is cut off from the clipped/cauterized ends, the entrapped nerve endings will die off after reversal. He didn’t seem to think the clean up method produced any better results. He was also adamant that there are so many fine nerve endings in the scrotum that just can’t be seen, even under microscope. I think that’s why he prefers to disturb as little as possible.

Keep in mind that Dr. Jarvi has been researching PVPS for a long time and has pretty high success rates for resolution of PVPS with reversal. https://www.ncbi.nlm.nih.gov/pubmed/22177173

His reversal method also allows for smaller incisions and presumably a faster recovery time.

I know there have been a few guys on here who have had reversals done by Jarvi or his associates and have been happy. Just my thoughts.


#9

Who is Dr P?
I haven’t had a sperm anayisis since surgery. I will have that checked soon.


#10

Thank everyone for their comments. I’m trying to find a micro-surgeon in the Atlanta that will do the removal.


#11

You may have found this already, there is a list of specialists in the site here, some of whom may be near to you:


#12

I am in Atlanta but flew down to the PUR Clinic in Orlando for the procedure. Dr Parekattil (Dr P) takes care of a lot of pain patients. You can call and he will do a phone consult, I think it is $200.

Or you could look around and make sure you find a Urologist with a microsurgical fellowship since you are not reversing.


#13

Thank you guys for the advice. I’m still looking for a dr. in the atl area.


#14

Have you seen Dr. Witt in Atlanta. When I was going through my initial bout with PVPS back in 2005-06, he was the go-to guy in the Southeast.


#15

Yes I saw Dr. Witt. He’s the one that does not think it’s the clamps that are causing the problem.


#16

Having thought about what to say here, I have concerns for you having the hemoclips removed at this point.

I’m not a fan of leaving them in when a reversal for pain is done, but wth do I know. Even top tier pvps docs can’t seem to agree on which way is better when doing reversal for pain.

The kicker in your story for me is, you said you started out doing better post reversal.

Having gone through a reversal failure early in my first reversal recovery, I’d tell you it’s quite possible that’s what’s happening to you. Just fyi, I had a second reversal approximately 12 months after my first one. I suppose it’s possible something else has went wrong with your healing as well, such as, entrapment/neuroma/leakage/etc, but these are my main thoughts.

You could always prove me wrong, have them removed somehow, and do better. Idk, as this would be a first to my eyes/ears.

I’m pretty smart with this vas stuff, but I honestly don’t know if removing the hemoclips is even possible without re-doing your reversal. If it could effect your patency, etc, etc.

Here we go again, but I’d honestly have to recommend the papaya seed powder option instead of TRT. Take it for at least 3~ months. If you have no reason to believe it’s helping, I’d consider moving forward with a possible plan B.

Plan C is wait this out indefinitely (12-24+ months) and go from there. Perhaps proceed with plan B again, or even another plan.

In the meantime, and before you start taking papaya seed powder, or TRT, get an SA done asap. That’s the first thing you need to address imo.


#17

Lot of good info! I will be scheduling my SA next week. I’m intrigued with the papaya. As the weeks go on I will keep you all “in the loop”. Thanks again.


#18

I had bilateral pain after vasectomy in 2012, reversal 2013 leading to pain resolution on one side. In Nov 2016 had been on up to 10 oxycodone per day, stopped 100% for 72 hours in spite of absolute agony. Suddenly, felt flowing feeling and commensurate pain loss: after 4.5 years of hell, divorce, bankruptcy etc a MIRACLE: no pain since.

Saw a different urologist from one who did reversal surgery to find out what happened and if pain could come back: “no idea, never heard of this, count your lucky stars and get back to living your life!”.

I said I had a theory, could this be it: “By not taking oxycodone, testicular pain increases, causing groin to tense, increasing pain etc in vicious circle until pressure on vas was so high it burst”?

Answer: that is a theory that would explain the evidence.
Do you have any other theory?
No.

In my case it was 72 hours of unimaginable agony - even if it takes a week, give it a try,


#19

P.S. my pain was associated with seminal fluid production, I asked urologist if there is a drug that reduces seminal fluid production, he said try Avodart. This helped me a lot - so if it helps you, it indicates you may be in same situation as me so then stop all pain killers until your vas bursts, however long it takes.


#20

Could be the clips, but you could also unfortunately be experiencing nerve damage from the original vas or even the reversal itself. Like said earlier there are such small nerve fibers in the scrotum and spermatic cord that even the microscope had a hard time seeing them. I have had every procedure you can have to fix his and I’m of the thinking now after one procedure actually made things worse that you should avoid having anyone else even open up the scrotum for further surgery unless it is a reversal . If your pain seems to be more nerve than congestion I’d get a block done at inguinal ring on genitofemoral nerve if that stops the pain then have the nerve removed there and inserted into muscle. Basically you are stopping the pain message from leaving the scrotum to get to the cord then the brain. Just my 2 cents. I’d also watch spermatic cord blocks they could possibly do more damage too if not done properly. Dr . p only does them with anaesthesia so your brain and nerves are turned off to avoid triggering more pain that’s why I would try block higher up first.