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PVPS and Prostatitis


#1

I have a close friend who is not part of this group but is having what I believe some chronic issues from vasectomy. He’s close to three years out and he’s basically had prostatitis almost constantly since surgery. It will go away with antibiotics but always seems to come back. He did have one small bout with prostatitus prior to vasectomy but it was short and not a big deal. He also has some minor PVPS from testis – but prostatitis seems to be his major problem. Another thing… How do you decipher between prostatitus and auto immune issues? Often times his prostate won’t be hurting bad but he is just worn out and sick… And of coarse the local urologists he’s seen are telling him there is no relationship between vasectomy and what he’s going through - they just give him antibiotics - but antibiotics seem to becoming less affective as he’s had so many…

I know that I have personally dealt some prostatitis since original vasectomy as I’d experience severe pain after urinating at times – straight from prostate… Something I never experienced prior to surgery.

I know at least a couple of you guys have had issues with prostate after vasectomy… Any input or ideas… Things that could help…


#2

How would you describe your friend’s symptoms? As I understand it, prostatitis can have a very broad definition. I had what some would call prostatitis (I felt like I was sitting on a tennis ball all the time.) Two things helped: pelvic floor therapy and my “Comfy Forever” cushion. (It’s the as-seen-on-tv cushion that you can get at Walgreens.)


#3

Agree with Tim. Prostatitis has become a catch all term that encompasses everything from chronic pelvic pain to the relatively uncommon bacterial infection (like 10% of cases). I had pelvic pains pre-reversal and felt like I was sitting on a golf ball on the right side and runaway inflammation. Sitting was awful. My symptoms were straight off the Wikipedia page for CPPS. All tests came back normal, PSA tests etc. My prostate was fine. I did have urinary issues - I had these weird waves of what felt like inflammation that would make me constantly try to go to the bathroom, even if I had just gone five minutes before . I remember one time my brother in law was in town and I got up 7 or 8 times at dinner to use the bathroom. My pelvic pains have mostly gone away with reversal. Maybe because it made me relax and stop clenching up all the time? I just haven’t had the sitting problems I had prior to reversal. Not perfect, but SO much better. I’ve experienced almost none of the weird inflammation issues post-reversal. None of those weird urinary episodes.


#4

Mar2k, Did you do your reversal solely for the pelvic pain, or did you also have PVPS symptoms? I’m curious to know if the reversal addressed both types of pain.


#5

Thanks for responses… His symptoms vary – wonder if there is a way to get him in this group. I told him about Dr. Marks and I guess he’s actually flying down to AZ. for a personally consultation. I would say that he usually has mild prostate pain and some minor PVPS… I know sitting in certain positions increases pain… But in general he’s just pretty sick…. Very tired and ill at times – will just have to leave work early to go home and sleep… etc… It’s funny, we’re both 35 years old and we used to be extremely active. We were big time skiers and climbers – we still do get out when things are good, but nothing like 10 years ago… It’s like all of a sudden we went from 35 to 55…


#6

Tim, when you say PVPS symptoms, I assume you are talking about congestive type pain or nerve type pain. The pelvic pain I consider PVP as well given that it wasn’t there pre-vas, so its hard for me to characterize them as different types of pain. As Dr. P has often pointed out, at the end of the day, all pain is ultimately a form of nerve pain. But no, I actually did not think the reversal would address the pelvic pain as much as it has, in fact, this was one of my biggest hesitations going in, since I was not convinced it would be the fix for everything that I was (and we all are) hoping for. I’ve been pleasantly surprised in regards to the pelvic issues and inflammation (significantly reduced) since reversal. I do still have some other issues which I am sure I will post about sometime, but overall I think having the reversal, regardless of any other benefits, may have served to more than anything to help me relax and break the pelvic pain cycle related to clenching and guarding my pelvic floor all the time. At least that’s how I see it.


#7

Hey Mar2k, that’s great to hear that the reversal helped with the pelvic pain. I’ve had both testicular pain and pelvic floor pain, which both resulted after the vasectomy. Both pain types have decreased for me over the last 18 months, but I’m not out of the woods. (I still take my cushion everywhere.) So, it is good to know that a reversal might address all symptoms if I decide to go that route. By the way, what was your recovery like from the reversal? Did Dr. P do it? Did you do the bio-wrap?


#8

Hey guys this is kind of where I’m at. After my reversal I had almost no prostate issues for 9 1/2 months. I got my reversal 5 years after initial vasectomy and had “prostatitis-like” symptoms the entire time. It was only after my reversal that they want away.

Anyway at 9 /12 months I got what felt like a UTI then had prostate problems then a huge return in pain on the left side and not at a year and a month or so It is finally settling down. The significant pain that returned at 9 1/2 months has settled down but now I have prostatitis type symptoms again. I think my left side may have closed off and that’s why the symptoms have returned. I am going to have another SA here in a few weeks. my numbers were high at 8 1/2 months but dropped at 10 1/2 months and held steady through the 1 year mark at the same level at 10 1/2 months. I am no longer in pain, just discomfort but man for a few months there things were awesome. I had to take a z-pak for bronchitis in Jan and things really cleared up. So was it an infection? I don’t know but I think for some of us if things aren’t flowing we get prostatitis or are more susceptible to. I feel strongly about this.


#9

Has anyone tried Balcofen for prostatitis like symptoms? I can’t remember where I heard it mentioned, but it’s been in the back of my mind ever since.


#10

Dear all,
We do have some men with prostatitis like symptoms. We usually utilize blocks (cord blocks, perineal blocks or trans-rectal peri-prostatic blocks) to try to help us in determining if we should go in the targeted nerve versus reversal treatment direction. If we go the reversal route, we would use the bio-wrap.
Hope that helps
Sijo Parekattil, M.D.
The PUR Clinic, Clermont, FL.


#11

Dr. P, would you mind elaborating? Why would you use the biowrap for reversals that are done to treat prostatitis like symptoms? Thanks! Tim


#12

Sorry for not responding sooner.
PVPS and peripheral pain syndromes - such as pain in the urethra, penis, prostate, perineal, peri-rectal, lower abdominal, upper abdominal and back areas is hard to explain. We are not quite sure who some men seem to get pain in these areas. One plausible explanation is that there may be some type to nerve irritation that has caused or is linked to pain referral or collateral nerve abnormalities in these areas. The only way win could be connected in these seemingly disparate areas is if there was some type to nerve connectivity or referred pain to these areas. If this is the case, then how would a reversal seem to help with pain in these secondary areas. We believe that at the time of reversal, there may be some targeted denervation of the vas deferens that is inadvertently performed when we are cleaning or freshening up the two ends of the vas that we are preparing to re-connect. Perhaps the benefit from a reversal is not only release of obstruction, but also a denervation or blocking of some abnormal sensory nerves in the vas deferens sheath (please take a look at the paper we just uploaded onto the forum for detailed discussion & explanation of the abnormal nerve fibers we found in the sheath right around the vas deferens in men w/ chronic pain & PVPS).

So if we are doing some type of nerve cutting at the time of reversal, then there may also be a risk of further aggravating these nerves in some men at the time of reversal. To try to reduce this risk, we have started using a bioinert-matrix wrap around the anastomosis - the hope is that this should help decrease the chance of neuroma formation and reduce granuloma formation (shown in a prior animal study). This may also have benefits for patients with referred pain or pain in other nerve linked areas - such as the groin, prostate, pelvic areas, etc.

This is why we think the bio-wrap has a role in reversals for patients who have pain in other areas.
Hope this helps explain our rationale,
Thanks


#13

Very helpful. Thanks!


#14

When I was recently speaking to the surgeon who is going to be performing my reversal he also brought up the fact that he’s seen in numerous situations where just by cutting the vas ends of some men during reversal it was enough to relieve pain. This helps to confirm what Dr Parekattil mentions here regarding nerves in the vas sheath being aggravated or trapped after vasectomy in some cases. Although most of my issues seem to be located in the epi caused by obstruction, I do occasionally feel an aching or burning sensation located where the vas ends were cauterized. I’m hopeful that a reversal will also help to alleviate those issues as well.


#15

Hello guys, this is my first post, went so far through 2 months of misery since my vasectomy, I am very sorry for all of us that are are on this forum. Three days after my vasectomy I developed what seems like prostatitis, boggy prostate, excess white blood cells found in the prostate fluid, no STDs, 43 days of 3 different antibiotics did nothing, PSA =1.0, low testosterone at 350. I never had any problems with prostate before vasectomy. I now have pain in penis root, penis, pelvic floor, both legs, recent minor groin pain, sitting is awful, three days after ejaculation are awful, sometimes pain feels like burning, not much testicular pain - maybe some behind testes. Mornings after waking up are actually tolerable, gets worse as day passes. No urinary issues exept on one occassion when it was very hard to push urine out. Seems that some of you got prostatitis relief after reversal. Did you have similar simptoms of prostatitis to mine with prostate inflamation? Or did you have just “prostatitis like symptoms” without prostate issues? I wish you all recovery.


#16

Vincent - I had a cornucopia of symptoms pre-reversal. It was hard to pinpoint the driver, the type of pain, etc. Among them, though, was a high PSA (>4.0 which made them worry about the big C) and I felt like I was sitting on a tennis ball, so I have no doubt my prostate was part of the equation. I was 40 at the time. These symptoms started 8-9 months after the vas.

I ultimately had a reversal and all of the prostate related symptoms went away. Recent PSA was 0.3, a drop of over 90%, so clearly something was going on. After my reversal surgery, doc told me I was “actively leaking” from both sides which had developed granulomas.

So, my belief (which is not provable) is that (a) the granulomas were partly causing the pain themselves and (b) I was having an immune system response to the sperm out in the open, and that immune system response was the cause of the prostate problems.

All speculation, but speculation based on a lot of input from guys like those here.

Reversal didn’t solve everything for me but I’ve been mostly back to normal the last 10 years. Dealing with another relapse now of nerve pain (95% sure). But, my worst day now with this relapse is still better than any day pre-reversal. I could barely work then.


#17

Thank you very much r4girls for the response, I am raising lots of fun 2 girls, they are fighting now in their bedroom, he, he. I was also thinking that I may have autoimmune response. I had open ended vasectomy. Seems that way to test this is to have Testosterone shots to lower or eliminate sperm production, plus my T level is low to start with. I will talk to Dr. Werthman next week. I wish you fast recovery.


#18

Good strategy. I guess the assumption is that you’re not congested if you had an open ended vasectomy. Seems like you’re on the right path.

I knew a guy from before the old Yahoo board who had an open ended reversed. Just one data point, and I’m sure you’ve got other bullets to fire before resorting to that, just letting you know it’s not an impossibility.

So you know, my T-level was 275 as measured once while I was in a vasectomized state. Seven years after my reversal, it was 605.


#19

Thank you.Only other pain killer that works for me is oxy but I don’t want to use it. What other things should I try in addition to testosterone to possibly get swelling of the prostate down and reduce pain? Doctor prescribed 4th antibiotic for me, Bactrin, but my gut is getting destroyed by antibiotics, I am hesitating.


#20

That’s a real tough question. Thinking back 10 years with what I know now, I know I had more than one pain source and a multitude of issues.

Nothing they offered really did anything for my prostate. Gotta tell you, though, it wasn’t the focus of my urologists. Though never said explicitly, I’m pretty sure my reversal uro KNEW right away I needed a reversal but put me through the non-invasive therapies (nerve pain meds, injections, etc.) as almost a prerequisite. I think he knew the prostate problems would go away, but he never explicitly confirmed the autoimmune part. I think that belief is almost heresy even among the uro’s that believe PVP exists.

Short of reversal, I’d bet on T-therapy as your best bet.

Remember, I learned after my reversal that I was leaking from both vas tips and had granulomas on both ends. That means that instead of back pressure and blow-outs, my sperm found a way to push through the cauterized vas tip. I think that means my body effectively converted a closed-end to an open-end vasectomy.

I say this because I think our situations are similar (I also had/have nerve pain, not sure if you do).

Nothing for 9 months solved my pains and symptoms I believe are attributable to leaking sperm into the open except being put back together. Again, one data point for you, but I think you now know my recommendation (based solely on my experience).