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Update - another surgical option not often discussed


#1

So, through a series of referrals, I found myself with a general surgeon yesterday whose specialty is treating men with post-hernia-surgery pain with laproscopic neurectomies of the GF and II/IH. I must thank @Acschiro for suggesting this option.

He’s sending me for a dynamic ultrasound and some other imaging to once-and-for-all determine whether I have a small inguinal hernia on the left (painful) side and also to see if there’s any detection of nerve damage.

Regardless, he feels confident a laproscopic GF neurectomy is a good option for me, 75% likelihood and even better if I continue to respond to the GF block (as I have before) that he also ordered.

Here’s the most interesting and relevant part. I asked about his approach vis-a-vis Spermatic Cord Denervation. He said he sees a role for SCD but not “for guys like you (me)” that have already had a vasectomy and reversal because of all the scar tissue we’re likely dealing with. He further suggested I ask any urologist proposing SCD what the probability is that he’d find all the nerve fibers containing (visible or microscopic) impacted by scar tissue.

By contrast, he suggested for me that going up the GF before it enters the inguinal ring is probably a better option even though it’s more invasive than SCD. He even suggested that, pending the imaging results, he may have to go further up the GF beyond the point where the GF branches into the femoral and genital branches!!!

So, yesterday, I received 100% agreement with @Acschiro’s theories on why SCD may not work as well for PVP sufferers as, perhaps, the general populace.


#2

I have been giving this a lot of thought and doing a lot of research on the neurectomy approach @raising4girls. I have actually come across a lot of studies recently tracking neurectomy out several years post surgery with positive outcomes in most cases. Its difficult to say what to do in your case and anyone else’s case. I can tell you I have this on my radar but not sure my pain level is high enough to consider it yet. I also still have a reversal on the table to consider. I would say if you have narrowed your issue down to a specific nerve then this may be a option to consider. I will also caution there has not been many stories published for PVPS and neurectomy. If you choose this route please keep us all posted on the outcome and good luck.

Here is one link but this is for Hernia patients


#3

Ben, thanks for the post. You’re right, I don’t see many instances for PVPS sufferers online being treated for neurectomy. Frankly, if not for this forum, I’d probably have already had spermatic cord denervation done, right or wrong. It’s what urology seems to recommend. Heck, I still might go down that path.

That’s one of the problems with Post-Vasectomy Pain Syndrome as a diagnosis. It’s too much of a catch-all. I was fine for 7 years 2009-2016 and then relapsed after bicycling. A lot of bicyclists develop scrotal and groin pain. I need to look and see how they’re treated.

In the end, if I can isolate with some certainty that the GF is a my culprit (or, confirming that numbing the GF relieves my pain), then it would appear I have GF neuralgia as a diagnosis. Sure, the vasectomy in 2005 and reversal in 2006 probably got the ball rolling with direct nerve damage and nearby scarring, but the cause is perhaps less important than the diagnosis.

What I really want to find out is if guys with scrotal pain (from any cause, be it bicycling, hernia surgery, etc.) get relief from GF neurectomy.

So hard to know. That’s why I’ve chosen not to do surgery despite hitting 31 months since this began.