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PVPS - everything you ever wanted to know and then some


#1

First of all, I have been a big fan of this continuation of the prior support site. I think those few that have worked so hard to educate so many deserve a real thanks.

Why I am here now after all these years. I have always kept a distance from being involved as I felt that this site was best served by those men with PVPS and those that had PVPS to be able to talk and share honest thoughts. It concerned me that if doctors had a presence, you might not want to be honest or that it might motivate us to want to try and sell ourselves to readers. But over the past and especially recently, with Victor asking specifically, I think it would be reasonable to include a series of articles on relevant and timely topics that we (Dr. Burrows and I) talk about with our PVPS patients- before, at reversal and when I go by and do my post-op house calls in the hotels while recovering and afterwards.

First a little bit about who we are and why I think we are qualified to be able to say these things (sadly so many are self declared experts, doctors and non-physicians).

About us. We have the International Center for Vasectomy Reversal (ICVR) located here in Tucson, Arizona. This is unique in that it is a full-time, reversal only center. We have almost 6000 reversals under our belt. I did my general surgery at the Mayo Clinic and my urology training in Boston at Tufts/New England Medical Center. I started my practice in 1987. Dr. Peter Burrows did his undergraduate world at UCLA, then his medical school at Ohio State/Cleveland Clinic, then his urology at USC in Los Angeles and his fellowship at Baylor in male reproductive medicine and surgery. We perform reversals Monday through Friday, on average 7 to 9 week on patients from every state in the US and more than 68 countries around the world. Though we are very busy, Dr. Burrows and I choose to limit our practice each to just one reversal each day. That way we know the each patient gets our full and undivided attention - we are not rushing off to do a second or third case nor we fatigued from an earlier reversal. I truly believe that our practice really offers a level of care, service and attention to detail unsurpassed in the world. About 10% of our practice our reversals on men with PVPS, though just this week we had four consecutive PVPS patients.

There are a few other things that make our practice unique. Every year at the annual international urology conference, I am honored to be the doctor gives the postgraduate course on state-of-the-art microsurgical vasectomy reversals. Plus to be certified in andrology by the American Society of reproductive medicine (ASRM) I wrote the module on the vasectomy reversals. And recently we had two major papers accepted for publication – one on the high success of reversals in men more than 15 years after vasectomy and the other showing a 99.5 % success using the Marks Vas Cutting Forceps (they named it and sadly I don’t get any money for sales of these). The point of this is not to brag but to show that at least in our little world of reversal doctors I am able to carry my weight and that my thoughts and comments on reversals and PVPS are not from a wannabe expert. Let me also say that of course there are many many excellent reversal doctors throughout the country. If you are talking with one of the top-tier reputable experts and you will get good care and good results. But remember to take everything with a grain of salt. I have my biases, as we all do, and of course as a reversal doctor to me that’s the smartest solution. But it’s not the only solution.

At this point these are the topics I would like to address. If anyone has any other suggested topics please let me know. If I don’t feel like I can speak to any points with truly expert knowledge then I might suggest others in our community who may be a better resource.

  1. My thoughts on PVPS and why does it affect some people but not others?
  2. Signs and symptoms, and why everyone is the same yet in a different way
  3. The variable and inconsistent natural history of PVPS
  4. Causes and myths of PVPS
  5. Conservative treatment options, including alternative therapies
  6. Aggressive and invasive treatment options
  7. Your own path and decision-making
  8. Pros and cons of doing your own healthcare research on PVPS (yes there are cons) and the dreaded analysis paralysis
  9. Why I think a correctly performed microsurgical multilayer vasectomy reversal makes sense for chronic refractory PVPS (bias alert)
  10. Recovery after treatment, short-term and long-term

#2

Dr. Marks, I would love to read your thoughts on all 10 of these topics. And, I’m sure I’m not alone. Thanks for joining the site. Tim


#3

Ditto that. I have gained terrific insight from all of the doctor’s posts, and greatly appreciate the input.


#4

I agree also and am stoked you’re part of this group…


#5

Dr. I am also one who would like to hear your thoughts on each of these subjects. Is it posted somewhere? I have yet to chose a determined course of action. I am 6 months post vasectomy yesterday. In the near future I am meeting with a urologist in NYC to determine a course. I believe before I take any action I will be waiting for your expert opinions and thoughts.
Thank you.
J


#6

Hey J, who are you seeing in NYC? I’ll be interested to know how it goes and if you feel good about the doc. I saw Dr. Peter Stahl at Columbia/NY Presby. He was the first “local” doc I found who knew anything about PVPS.


#7

HI Tim
Sorry I didn’t se this and haven’t been on line.
I consulted w. Dr. P in Oct an dhe mentioned to give it a little more time being I was only 2 1/2 months out.
I have been seen by Dr Tojino from Premier 1st and last at the moment. My GP has been my primary point of contact at this moment. I am scheduled to go into see Dr Joseph Alukala (sp) in Mid town… It tough with the three kids and work to get the time…
Actually one waking up right now teething… hence the vasectomy
How are you doing Tim?


#8

HeyJ. Hope your pain has lessened. I’ll be interested to hear your thoughts about your experience with Dr. Alukal. …I’m up and down, with enough pain to feel limited, but not enough to risk surgery. Caught in no man’s land and a bit frustrated. Take care, Tim


#9

Tim, Sorry to hear about your ups and downs with PVPS. Have you started any intervention? Medical? Compressive underwear?


#10

Big thanks to Dr. Marks and other physicians for taking on post-vasectomy pain patients. No doubt, it’s a challenging ailment to resolve. I sincerely respect you all for helping men with the PVP affliction.


#11

Tim that sounds exactly where I am, not enough to do surgery but some days I have these set backs that kick my a#@ and I want the reversal. I am a very positive person with a ton of energy. I was a personal trainer and loved to exercise but cannot anymore. When I start to get the symptoms it just destroys me, and I still try to focus on better days though. Do you have any immunologic issues? I’m trying to understand what is meant by this statement? from what I can tell some of my symptoms feel like this. Low level energy (not all the time), and slight feverish feeling is the best I can describe it. I cannot tell if it’s anxiety or immune. I don’t see a definition for it. How long have you been suffering? I am still green just passed 6 months but it feels like longer.


#12

I’ve tried a bunch of stuff. Pelvic floor therapy was pretty helpful to a degree. NSAIDS and antibiotics weren’t. I took gabapentin for a long time. It eventually resulted in memory lapses and didn’t do much for the pain, so I stopped. I had two nerve blocks: one directly in to my epi, which caused a lot of bruising and pain, and a more comprehensive bilateral block done under sedation by Dr. P. It did not help. Exercise helps (even if at times it just takes my mind off the discomfort.) I walk on a treadmill and lift weights and that makes me feel healthy. I’ve also been taking 5,000mcg’s of vitamin B-12 because Dr. B mentioned the theory that deficiencies may explain some pain situations. Oh, and yes, I wear tight briefs now. No boxers or boxer briefs.


#13

Hey J, you might try having a blood test done to check for anti-sperm antigens. Sometimes an autoimmune response to sperm in the blood stream is the cause of pain. (I did the test at Quest and it came back negative.) That feverish feeling that you mentioned might be an indicator, but I don’t know a ton about the AI thing. I’m sure it doesn’t feel “early” to you, but some medical experts would say that it is too early to assume that you have a chronic situation. In fact, I had one urologist who told me that he informs all his patients that it can take up to 6 months to recover under “normal” circumstances. Also, adjusting from being active to being unable to do the things that you love is very difficult. I was pretty passionate about karate until this happened. I’ve had to give it up for now. Thankfully, I’ve been able to introduce brisk walking and weight lifting, but that took over a year. I found that talking to a therapist for a while about my struggles with the limitations was helpful. Often PT outfits will are able to connect people with therapists who deal with pain. Hang in there. Tim


#14

I don’t agree with some of the things your doctors have told you.

  1. 6 months is a hell of a long time to live with severe life destroying pain while the doctor says you have to ride it out. I have done many thousands of vasectomies over my decades in the business and if the patient has that severe pain for a week then I am worried and concerned.

  2. Matthew here in my andrology lab did his master’s these on the role of sperm antibodies. He looked at more than 100 patients that had reversals and followed their antibody levels. Of course a reversal provides the same sperm exposure to h the body’s immune system so it seems safe that one could assume the same immune response after vasectomy. What he found was that antibodies are almost random and the presence, absence and % often fluctuated widely, was stable, increased over time or decreased over time and varied from person to person, test to test. Not sure relevance here for PVPS…


#15

why was everything in bold and giant font?


#16

I thought you were yelling at us. Lol! I’m glad to get your response and to hear that even one week of pain causes you concern. As a person suffers from pvp it is really hard to know what is considered “normal” and what isn’t.


#17

I edited your post to remove the bold giant font. :smile:

The text editor uses Markdown formatted text. I think that details were in the initial account creation email, but I’m not sure.

For your case in particular, the ‘#’ characters denote that you’re writing a ‘heading’.

Here’s the syntax reference :

http://daringfireball.net/projects/markdown/syntax


#18

@DrMarks can you provide a link to Matthew’s master’s thesis? If that’s not available, can I get the contact information for his thesis advisor? I can make a request to get a copy of the thesis from his advisor. I think that would be a good point of reference for people on the group.


#19

Matthew is working on getting permission as we speak.


#20

Dr. Marks,
I am curious, does the reversal ever close up completely and stop leaking sperm into the body? Maybe this is a dumb question also, but how does the vas after reversal and stitching- heal up? How does it grow back together? I understand muscle healing, bones healing, what is the vas material. please forgive my ignorance.