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Spermatic Cord Denervation - when to go ahead


#1

Had a reversal, which made things a bit worse. Pain is in the cords only. Struggling to perform on the job but can at least obtain pain relief with ice and rest. Haven’t had Spermatic Cord block, should I even consider cord block and denervation? My fear is the Doctors will only further worsen the pain. I believe that the Urologists lie about success rates and risks. I need real advice and stats.


#2

For the most part, cord blocks are pretty harmless. That’s not to say they feel good but rarely do they damage anything. Think going to the dentist, getting a shot, and being numb for 5-6 hours. That’s essentially what they are doing…a nerve block.


#3

@crotalus97 How long ago was your reversal? I would avoid doing anything for at least 6 months if not a year. Anytime you reenter the area, you risk more damage. Are you taking any meds to help? Might be a good idea to try some of the ones mentioned on this forum to help you get through the next few months. Your body might heal while on them and you might be able to about further surgery. Obviously they can have side effects but talk to your doc and decide what might work for you. I agree with choo that a nerve block is relatively simple, but it won’t provide long term relief and some on this board have gotten worse after them. Plus, sticking a needle where you are already dealing with inflammation and scar tissue doesn’t seem wise during the healing stage.


#4

I am 10 months out and on Mobic, cymbalta, st. johns wort, ginger, lipoic acid, vitamins B and C. It’s still up and down for me, for example two weeks manageable one week not. what else do you recommend?


#5

Well, 10 months out, sorry you’re here man. I think at 10 months there is certainly still some healing that could take place, but thinking about your next step is warranted. Two med types you could consider, that men on this forum have gotten some relief from, are Amitriptyline or Nortriptyline and Neurontin or Lyrica. Might be worth asking your doc. Beyond meds, pelvic Physical Therapy is a relatively easy and conservative step to try first. Good luck.


#6

@crotalus97 - Definitely get a cord block before doing denervation!!!

It’s a good predictor of how you will feel after denervation.

Frankly, I’d be shocked if a surgeon was willing to do denervation without doing a cord block first.

On January 8th I had a block done by Dr. Jarvi and had good relief (maybe 50% reduction in pain, hard to put a number on it) for about 3 days…then got worse for a week and am now just kind of settling down to baseline.

According to the medical literature, this means I’m a good candidate for denervation. :grimacing:

I have almost zero testicle pain after my reversal. It’s cord, groin, abdominal, penis, right thigh, perineal. Dr. Jarvi really didn’t think the block was going to do much for me, but I had taken the whole day off work and braved a friggin’ snowstorm to get to Toronto, so yeah I did it. He blocked the II and GF nerves under fluroscopic guidance. The syringe was a MASSIVE 60cc, but once the anesthetic started going in, it was pretty well painless. About the same as getting a flu shot. Except in your groin.

Surprisingly, it helped with my thigh pain, groin pain, cord pain and even penis pain. Weird, right? Dr. Jarvi couldn’t explain it, well no one can explain what the hell’s going on, but he described treating PVPS patients as something to the effect of ‘doing magic tricks.’

Personally, I think the steroids mixed into the block made me worse for a while and I think I should’ve insisted on just anesthetic with no steroid. A lot of my reading about chronic pain treatments are revealing that steroids and cortisone shots aren’t really doing much and might actually be having the opposite effect.

Think about it, when was the last time you saw someone raving about how great their steroid shot was?

As for today, I’m not doing much worse if any, but I still feel like I’m bruised where the injection was. I think, maybe, just maybe, that the block helped me with my penis and cord pain…just slightly.

Anyways, before you do cord denervation, get a nerve block to see if it’s going to even help you, and whatever you do, make sure the block is done under imaging guidance (ultrasound, flouroscopy) and done by an experienced pain management doc or urologist, and maybe consider not getting the steroids mixed in. Up to you.

Sorry for the long winded post, I just wanted to try to put your mind at ease so you know what to expect. Good luck to you and keep us updated.


#7

Thanks so much for your response. Can you educate me? My pain is only in the cords near the vas sites. Does this suggest spermatic cord pain or could this be other nerve pain? Pain doctor gave me option of trying first a Genitofemoral block or a Spermatic Cord block. What might you recommend?


#8

I’d look at genitofemoral nerve, ilioinguinal nerve or ilioinguinal nerve resection before doing denervation in my opinion it is less risky. First you need to find out if which nerve is causing the cord pain.


#9

what is resection? I’ve never heard of this when looking how to resolve pvps.


#10

They go into the inguinal ring cut the genitofemoral nerve that goes to testicle and bury the nerve in a muscle to avoid neuroma. The cord is composed of small branches of the II and GF nerve that are smaller than a hair. Basically they are going up higher on the nerve and stopping the signal before it gets to the spermatic cord. I wish I would have went this route instead of denervation.


#11

@Acschiro - What are your thoughts on triple neurectomy? It seems to have pretty good success rates and makes a lot more sense than denervation.

I spoke with Dr. Jarvi about it a while back and he was concerned about the potential for back problems, postural problems, etc. because the nerves were being cut out higher.

Here’s a good article of a female pelvic pain patient who had excellent results from it. I know we’re all males here, but the principles should be the same, I think.

http://www.jogc.com/article/S1701-2163(15)30336-4/fulltext


#12

Way too hard to say. When you say pain in the cords near the vas sites, you mean you were accessed up high? I think cord pain is usually higher up, like in the groin, all the way up to your abdomen.

Maybe do the GF block first, then an II nerve block if that doesn’t work. You can also do a cord block too, which will block the GF and II. Hard to say which option is better.


#13

I’ve contemplated it seems to work well with hernia patients that developed nerve damage. If you have the Gf nerve by itself blocked and the pain goes away you wouldn’t need the triple neurectomy only removal of the Gf nerve at inguinal canal. They worry about the ilioinguinal and ikiohyposgastric because it also has motor supply to the core muscles so cutting it up higher could cause weakness in those muscles. I specifically asked Dr dellon about this and he said the triple neurectomy would not cause muscle atrophy of the core muscles so it’s a he said she said type of thing. But the Gf only controls the cremaster muscle so even if it no longer works it’s not going to affect your core or posture. In my opinion it should be done instead of denervation a just makes sense to cut the nerve above the damage and before it turns into a thousand wires smaller than a hair.


#14

I have all the back and postural issues that you speak of @vasregret . That’s why most PT’s I’ve worked with suspect I had a stretch injury on the cord. Given where vasectomy takes place, there’s really no other way for my core mucles to be affected like they have unless they were stretched or tugged on from below.


#15

is there a name for the procedure of removing the GF nerve?


#16

GF nerve resection, neurectomy or neurotomy. There’s probably other terminology too.


#17

has anyone here had that done specifically?


#18

I think Jesse did after his failed denervation surgery.

Dr. Dellon and Dr Eric Williams would be the place to go to for this. Dellon’s website has some pretty in-depth articles about pelvic pain.


#19

man i bet that’s not cheap.


#20

If the problem is with the GF what about trying Dorsal Root Ganglion DRG before nerve resection or neurectomy?