PVPS - everything you ever wanted to know and then some


The reversal, when done correctly by a skilled expert, restores the flow so that no sperm leak out into the tissues. On rare occasions the body’s healing can slowly scar up the connection which is why we tell our patients to keep tabs on the connection status with a regular semen analysis. All tissues, when the body sees injury ( and this includes surgery- the body doesn’t know that you want this done)- responds to the injury with a cascade of chemicals and special cells that help heal - they stimulate new blood vessels to draw in more nutrients on oxygen and remove waste. Small cells that are like little muscle fibers also move in to help pull the damaged edges together. Aware of this, we do a number of things before, during and after the reversal to minimize any excessive healing and scarring. The most important is precise delicate surgery to minimize trauma to the tissues. I believe this is one reason why the occasional or quickie discount guys do not have the success of a senior experienced microsurgeon.


Thank you for your reply, the body is so fascinating and remarkable. Your input is so valuable to most of us and so appreciated. It helps in trying to navigate in this troubled water.


I have to echo what J said. Thanks for all the information you are providing Dr Marks, it is greatly appreciated.


Dr. Marks, do you mind sharing other actions that you take to reduce the scarring potential after a reversal? Thanks again for all of your remarks. They have been very helpful!


I’ve never listed it all before, as it really is as much an attitude approach to correctly performed microsurgery - and Its a combination of simply applying all the principles we have learned and perfected over many decades of correctly performed surgery and precise, delicate care with respect for the tissues and preserving blood supply, avoiding cautery near the vas, tying the knots just right- not too tight or not too loose, not touching the transected face, minimizing traumatizing nearby tissues, addressing any oozing or bleeding, minimizing risks for infection, using only the very best microsutures specifically engineered and designed for reversals with the correct microneedles, using only the very best microsurgical instruments and surgical microscope ( sadly, yes, many use cheaper imitations) and so on. Key is to find a reversal expert that is a true expert and is driven to be the very best. I worry about so many self proclaimed experts that are not really experts, and seem more focused on cramming cases through than taking the time to do each and every one the right way with respect for the anatomy, the techniques and the patient.


I think there is still a lot we do not understand about how reversals help men with PVPS. Our prior anatomic studies have shown abnormal nerve fibers in the peri-vasal tissues (the tissues right around the vas deferens). This may explain the phenomena of some men getting worse after a reversal. We have developed a few new techniques to try to further reduce the possibility of irritating or increasing sensitivity of these nerves in this area:
a) we try to pre-block the area with steroids and anesthetics according to a unique nerve distribution that we found on our anatomical studies (feel free to visit!chronic-testicular-pain/c4oy ) to get a copy of this paper. This was published in the Journal if Urology in July 2013 and was chosen as a CME paper - recommended for urologists to read and be tested on for CME credit). This we believe helps to reduce the chance of aggravating the nerves and increasing pain.
b) We tend to perform all our reversals under short acting general anesthesia with nerve blockade (you can only give nerve blocking agents under general anesthesia) to block any & all pain receptor pathways that may lead to increased pain from the procedure itself. We have copied this concept for pain management specialists who recommend that we block pain pathways prior to any potential surgery or trauma to any sensitized area.
c) we are the only center now utilizing a new bio-wrap material to protect the anastomosis to provide a number of benefits: it prevents any potential micro-leakage of sperm into the surrounding tissues in the early healing phase of the reversal and decreases the chance of granuloma formation at the reversal site (based on rat studies performed using the wrap versus controls without the wrap), Feel free to take a look at a video showing this technique at:!chronic-testicular-pain/c4oy
There is still a lot yet to learned about why reversals help in men with PVPS. Perhaps we will develop more refined and less invasive treatment modalities in the future.
Hope this helps
Sijo Parekattil, M.D.
The PUR Clinic, Clermont, FL.

   I feel I can speak with authority on this topic. I have had a bi-lateral reversal, bi-lateral spermatic cord denervation, approx 6 bi- and uni- lateral targeted nerve blocks, uni-lateral cryoblation, and Botox injections.  
   My body tells me that the idea that unclogging the pipes with a reversal will cure this is bunk. I had a return of sperm and I was in more pain and agony. It just stirred up the hornets nest of nerves down there.   Maybe the reversals that help pain are lucky that they stir up the nerves just right, but I would never go that way again.  
     4 months after the reversal I put myself under the care of the most compassionate dedicated doctor you can get.   He never gave up and continued to try procedure after procedure until something clicked. 
      Full disclosure,  even after all those procedures I was still considering right teste removal, but then improvement started and has continued for 11 months.   


Tim can you tell me where you are symptom wise? Did you ever have a reversal? Did things end up just going away? Thanks so much.


Jnich can you tell me where you are symptom wise? Did you ever have a reversal? Did things end up just going away? Thanks so much.


My symptoms are significantly reduced. I never had the reversal. I just waited it out, trying lots of different meds and physical therapy for my pelvic pain symptoms. I’m not perfect, and I still don’t engage in really jarring physical activity, but I can live like this. Where are things with you?


How far are you out from vasectomy? I am 6 months out. I have had all of the prostatitis symptoms since three days after my procedure. I have had windows of bliss after antibiotics and graminex flower pollen. Usually two weeks max until I have another flare up. I was doing good for another two weeks on some Chinese herbal medicine but things got bad again last week. I think ejaculation is the only thing I can pin point that aggravates things if it is done consecutively. My biggest complaints usually are abdominal pain, sore or painful hip flexor/groin muscles, random sharp Perennial pain, feel like I am sitting on tennis ball, and pain at the root of penis.

I am wondering if I can go for a reversal and hope to be done with this craziness. I couldn’t care less if I was firing live sperm again to live life again without thinking about this mess. Every time I have a good window I think maybe this will be the end of it. That does not happen.

I have ordered some cystaprotek but chances are it will tear up my stomach. Quercetin seems to upset it as I could not take Prosta Q because of it. I will try freezing the pills. I have also gone to a pelvic floor therapist but that was a joke. I am a very active person and the stretches they had me doing were elementary. I still play tennis, and swim, and exercise in general. If I go for a run my hip flexors and groin will bark at me for it.

I could go on and on.


Waking up now with the familiar dull ache in the lower abdomen and pubic bone area. It is hard to tell if it is a “full” feeling like congestion or what. I am so tired of playing the guessing game with what could be causing what.


Hey @fj23 hope all is well and your doing better. how is your hip/flexor/groin issues? I have the same symptoms on the left side. Now can’t tell if the pain originates from testie out to groin/hip area or vice versa… If i hit the treadmill i get the same screaming of my hip flexors/groin. Also if got it under control can you share what you did to help alleviate the pain?


Hey Nick! Are you from NC? Glad you reached out. I have actually been doing pretty damn well…and feel like it is getting better and better. My current regimen is

Graminex Flower Pollen - 2 pills three times a day

Pumpkin Seed Oil (Solary brand?)- 1 pill in the morning

That is it!!

Let me explain in more detail though. I have taken the Graminex Flower Pollen off and on since this started. There is no question it helps…takes the edge off…but did it make everything vanish? No it just made things a lot easier. Taking 2 pills three times a day is very annoying though…and a reminder of why you are taking it.

Pumpkin Seed Oil!!! I just started this three weeks ago or so after a lot of research. I am not sure how I did not take this before as I did eat actual pumpkin seeds daily when all of this started (does not work the same). There is no question that the pumpkin seed oil has been helping my prostate which I think is the cause of all these stupid ass symptoms.

No dribbling

Unit does not look like it is struggling for dear life (especially after ejaculation)

I ejaculated the other day and I swear I could have hit something 10 feet away (tmi…but it was awesome as for a year and a half my pressure was nada as if something was blocking it off)

Don’t even notice pain anymore

I actually ordered some Austrian Pumpkin Seed Oil from overseas as well to give it a triple punch. It is supposed to be the best from there.

What questions do you have for me?


Hey @fj23 no am actually from Toronto Canada :slight_smile: NC is just my initials. Glad your feeling better, i assume more of the symptoms were related to prostate issues and taking the pumpkin seed oil and flower pollen is meant more for prostate issues…


Do you think this would help you at all?