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Post Vasectomy Pain Forum

Right chord pain


#41

Ive been keeping an eye on this thread. So sorry for your boy.

Any chance if he is in that much pain, could they sedate him so he sleeps and at least while he sleeps he’s not in pain?


#42

I will be thinking all day on Wednesday about you and your son as you travel. I am so sorry to hear that he still has such a high pain level. This is not in his head! That is so ridiculous to say. I had a crummy day at work, written up for my “absenteeism” due to several appointments over the last two months for my son and now on 60 day probation. Never mind that I have stayed on top of everything all along. Thankfully my son’s next procedure with Dr. P is over Spring Break when I am taking vacation time. Please let us know how it goes!


#43

I feel that we are fighting little battles on a daily basis. We have won some and lost some. As my 16yr old tells me to get him the … Out of the hospital and he’s is done with it all. Today we are at the PUR clinic in FL. for the micro cryoblation procedure. This battle we will Win!!. I have lost the insurance battle for this procedure but as all of us have found out we are dealing with very uneducated people in the insurance industry. I will let all know how it goes. Ryans first smile in a very long time came today! At the PUR clinic we ran into a 16yr old. As his father and I talked my son seemed like the kid I use to know. We talked about how we found this place, what we have done to educate ourselves, and besides all the frustration we have gone through along with Spedred, THE one thing that keeps comming up is the blog. To all I thank you and I pray everyday that my son and all on this site may one day have a pain free life.


#44

As I sit here in the waiting room my thoughts wonder. How is it that there so many in pain and yet there are so few that really know what to do to fix it. I consider my family luck to have the resources to be here. Don’t get me wrong I would consider myself middle class at best but there is nothing that we wouldn’t do for our son. Money aside what are other kids out there doing that are in this pain. Have they been sold down the road as 1) “it’s in their head” 2) take these pills and it will go away 3) insurance can’t pay for it and we don’t have the money to get there. 4) parents not willing or have the time to find this blog and do the work to educate themselves. It’s the job of every urologists to look furthe, do more research but will this happen. Is it that these problems aren’t gloryifing enough for Doctor to find their fame? Is it the money, fighting with insurance companies and telling a person in pain that they have to pay out of pocket. (Thanks discover card and the third job I will get to pay it off) I need real numbers how many teens suffer with this? How many are be sold out? How many adults. I ramble. I’m nervous.


#45

To all who read this!!! Why is there not a list of all docs who have helped someone on this site. Like Dr. P is he the only go to guy? Is there a nerve doc all should know about? Where would you put this info for all to see? This will take some time and brains. Who will step up? Have I missed it through all of millions of web search.


#46

I’m pretty sure there is a list of providers somewhere. You can ask Victor. That’s a good question.


#47

The short answer is there are very few doctors who specialize in this. Dr. P and Dr. B are among the few. Dr. Fenig is another doctor who performs denervation along with a handful of others.

You will probably have better luck looking for a Urologist that specializes in fertility that is a trained microsurgeon - then seeing if they also treat testicular/scrotal pain.

Here is the “Playbook” that was put together by someone on the old Yahoo Orchalgia group. As you can see, most if it doesn’t require someone to be a specialist. The problem is so few Urologists know anything about pain or what to do about it.

--------------THE PLAYBOOK--------------------

  1. Characteristics of Testicular Pain
  2. Duration of pain (chronic defined as >3 months)
  3. Location of pain
  4. May be unilateral or bilateral
  5. Associated urologic symptoms
  6. Hematuria “Blood in Urine”
  7. Hematospermia “blood in the ejaculate”
  8. Dysuria “Painful or difficult urination”
  9. Erectile Dysfunction (Impotence)
  10. Previous urologic surgery
  11. Vasectomy.
  12. Genital trauma.
  13. Prior Hernia Repair.
  14. Comorbid conditions
  15. Major Depression.

Causes

  1. Idiopathic in 25% of cases “arising spontaneously or from an obscure or unknown cause”
  2. Intermittent Testicular Torsion
  3. Post-genitourinary surgery
  4. Sperm granuloma (post-Vasectomy)
  5. Varicocele *Extra Veins in the scrotum
  6. Testicular Cancer (painless in 60% of cases)
  7. Genitourinary infection (e.g. STD)
  8. Testicular Torsion
  9. Torsion of Testicular Appendage
  10. Epididymitis
  11. Orchitis
  12. Traumatic injury to scrotum
  13. Strangulated Inguinal Hernia

Evaluation

  1. Assessment for Acute Testicular Pain is critical
  2. Assess for referred pain
  3. Nephrolithiasis in the mid-ureter (most common) “Kidney Stones etc”
  4. Radiculopathy
  5. Genitofemoral and ilioinguinal nerves (T10-L1)
  6. Causes
  7. Inguinal Hernia
  8. Radiculitis “swelling in the nerve roots due to local trauma.”
  9. Entrapment Neuropathy after Hernia Repair
  10. Sperm granuloma

Signs

  1. Complete Male Genital Exam including rectal exam

Labs

  1. Urinalysis
  2. Urine Culture
  3. Expressed Prostatic Secretions when indicated
  4. Gonorrhea and Chlamydia cultures

Radiology

  1. Ultrasound with color flow doppler of scrotum
  2. Consider Spiral CT abdomen (CATSCAN) or intravenous pyelogram (XRAY)

Management

  1. Step 1
  2. NSAIDs
  3. Adjust posture if due to radiculopathy
  4. Empiric antibiotics for 2 weeks or more
  5. Cover Chlamydia and Ureaplasma
  6. Doxycycline
  7. Ciprofloxacin
  8. Step 2
  9. Spermatic cord block at pubic tubercle
  10. Bupivicaine (Marcaine) 0.25% 3 ml and
  11. Methylprednisolone 40 mg
  12. Inject no more often than once monthly
  13. Trascutaneous Electrical Nerve Stimulation (TENS)
  14. Step 3
  15. Multidisciplinary Pain Management
  16. Antidepressant medication
  17. Psychotherapy
  18. Step 4: Urologic Surgery
  19. Orchiectomy
  20. Surgical denervation Testes along spermatic cord

Basically the list is intended to guide a doctor through a comprehensive workup of the patients symptoms to try and identify a cause of pain. As you can see my the surgical treatments (Step 4) the options are limited if time and medication don’t work. For guys who suffer from PVPS you can also add open-end conversion and vasectomy reversal to surgical treatments.

You will find most urologists are reluctant to treat it because they fear that the pain is “referred” pain and - even though the purpose of the playbook is to rule out alternate causes for pain.

I’ve actually talked with “Top Docs” in my town that haven’t even heard of Microsurgical Denervation of the Spermatic Cord - and these are the people we rely on for treatment!

Most doctors you’ll run into are happy to try time and medication, perform some imaging work, then throw up their hands and say nothing can be done - go to pain management. That’s my problem with pain management, it allows doctors to be lazy and not try past a certain point.


#48

I’m sure I’m linking this wrong - but here you go. Most doctors on the list are reversal specialists. If they are a fellowship trained microsurgeon you could always contact them and ask if they perform denervation.

----> Click on the blue “PVPS Specialists” and it should take you to the thread.


#49

@Rmd123 thinking of you tonight after the cryoablation. My son was in a ton of pain after that procedure, so do not be too alarmed.i sure hope that it works for your son! We are feeling the financial pressure too on our family. I am praying that our 2003 Honda will last a while longer because we can’t take on a car loan and pay the outstanding medical bills. We have also been in touch with Dr. Dellon in Maryland , but we have not been to see him yet. We are heading back to the PUR clinic in a couple of weeks for another cord block. We have not tried Amniofix yet with Dr. P. Dr Dellon does surgery to remove the nerve. This is considered to be a very aggressive approach, and we are not quite ready for it. I hope we hear some good news soon on your son!


#50

My son just went back. 7:45 Florida time we will post tomorrow. As always we will keep all of the boys in our prayers. Don’t give up the fight!!!


#51

@Rmd123 How is your son doing post-cryoablation?


#52

Not as good as we thought it might be. Very long story, but as you know there has been no quick fix, that we all need. It’s a true battle on all fronts and we are not winning neither mentally or physically.


#53

I am there with you. I feel heart broken a lot, and I try to pick myself up and get back in the battle for my son. Our boys are just starting their lives. Thursday was the 1 year anniversary of the torsion surgery for us. I remember that Dr. P said that it would take a few weeks to know if cryo worked. Hang in there.


#54

You have been great. Thank you. Dr P was awsome but doing pain management in hospital. We’re with pain management team and mental health team. It’s a long story and will explain all later. Who is in charg of the blog. We need a 18 and under subsection. I ran into a dad I’m Fl at Dr P we are texting now. We’re running into more kids not s good sign. But the more we share the more we can all be informed.


#55

Very interesting. My son had a follow up appointment with his pain management doctor today, and I could not go because I am under a 60-day review for my job. I tried to listen in on the phone, but I could not hear very well. I would really like to talk with you. I am sending my phone number in a private message. Do you know how to check for that?


#56

My pain management team at the hospital has a psychologist I have to see as part of treatment. I actually like that, it gives me someone to talk to about what I’m going through who is involved with everything. That doesn’t mean we get any further treating the pain but talking about it with someone helps.


#57

Just wondering if any one has had any professional input on pudendal nerve or pelvic floor issues causing or an being an effect of cord pain? I have blogged in another vine on this site-“Vit/Herbal supplements” and Radar has had some comments for me, but just thought I would check on this string too, to see if any of you have had any experience from Urology or Pain management etc. on this being a cause/effect or related? Also, if relaxing of pelvic floor gives any relief via PT? I am not affected but trying to help and research for a friend who is affected.
Thanks


#58

Wanted to check in and share re my friend…so denervation didn’t seem to work, cyro may have worked or the PT he is seeing who is working him out for pelvic nerve inflamation. The PT only works with male issues in urology. This started 2 weeks after the cyro, plus large doses of gafipentin tid is ongoing Don’t know what is working, but one or combination of the above is working! Seeing mental health now too, for support but no more narcs and although still some tingling and low grade pain he is finally going the right direction. Back to daily normal living and physical activity. The PT is working on nerve intrapment some type if stretching and deep tissue massage 2-3 times a week. Again, don’t know what is working but it seems to be for now as always fear it will return but I wanted to share.


#59

Hello everyone, I have a 16 year old son suffering from the same symptoms found on this thread. He is in constant pain, sleepless nights, missing school and most important not enjoying his life. Apparently his testicals pain started a couple of years ago but did not mention anything to us until recently. We made appointment with a urologist and he determined that is was from torsion. He had the surgery on Jan, 12 2016 to stitch his testicals down. Since the surgery he is still in a great deal of pain with no answer from the urologist, he thinks it’s in his head, not to bright for a doctor to think that . Family doctor is reluctant to prescribe pain relive that he needs. I do want to thank Diane, who posts on this forum and for recommending the PUR clinic to us, turns out we live down the road from the clinic and we have a oppointment on June 29th. I will keep everyone posted on our progress and hopefully we can communicate together. I think it would be great if our sons were able to speak to each other and let each other know they are not alone.
Frank


#60

I’m guessing he had the Bell Clapper deformity. I don’t know why providers can’t accept that surgery on testicles can cause chronic pain. Liability? Fear of being the prescriber on the hook for writing a script for pain medication. It’s no wonder people start using heroin and hard drugs. It’s nearly impossible to get a script for narcotic pain medication in this country. I tried and it was not worth the hassle so I live in pain and it sucks.