I think it’s fair to say that the typical heard mentally or understanding of VR for pain involves just congestive symptoms, fertility, etc, and that is completely understandable.
I also think it’s fair to say that a significant amount of people don’t think this out well enough. They don’t do enough homework to connect a lot of dots, etc. That is completely understandable too. There was a lengthy point in time where I was like anyone else. I was new to these topics, I was unaware of so much, and I had the typical heard mentally about VR for pain, among other related things as well.
Hopefully nobody assumed that I do not support various non typical versions of vas to vas (vasovasostomy) for PVPS.
What I have said to many people many times is - get it right the first time. In other words, don’t submit to a variant of vasovasostomy that you do not understand, that you know nothing about, that may not be the correct choice for your perticular symptoms, that doesn’t fit your goals, etc. I have seen to many men learn the hard way, including myself.
If a man has tell tail signs or predictors regarding the congestive end of the spectrum, would it make any sense to choose a variant of VR that doesn’t seem to address those issues?
If a man has tell tail signs or predictors regarding hemoclips, would it make sense to choose a variant of VR that doesn’t address those issues?
If a man has tell tail signs or predictors regarding scarring or potential nerve entrapment at the proximal end/s of the vas, would it make sense to choose a variant of VR that doesn’t address those issues?
What if the man has a combination of such tell tail signs? What variant would be better or best then?
These are some of the things that every man should be aware of and considering for himself. Any experienced PVPS VR surgeon or any VR surgeon in general should be helping you consider such things before they recommend any sub variant of VR to you.
In however many cases, it seems that the ~majority of PVPS VR surgeons and VR surgeons in general do address many, if not all of the potential possibilities for pain in one swoop.
In other words, they do a clean up of both the proximal end of the vas that includes the removal of anything and everything that is visually damaged. Anything and everything that wasn’t there prior to the vasectomy - sperm granuloma, scarring, hemoclips, etc, and a clean up of the abdominal end of the vas during the VR procedure. Generally speaking, they are aiming for fertility.
This is where things start to get more complicated.
There are a significant amount of men that do not have any of the tell tail signs of congestive related complications. Many of them never had hemoclips used during their vasectomy either. Whether their pain began in the former or the latter timeframe, they don’t seem to have any tell tail predictors that would lead them or their doctor’s or surgeon’s to assume anything obvious as the source of their pain.
I’d guess that in many cases, the man or even his wife, etc, isn’t to thrilled with the idea of being fertile again as part of a surgical option for pain relief.
Obviously, there are sub vasovasostomy options (variants) that do not involve fertility as part of the outcome. In theory that can be supported in many ways, I can understand how such sub variants of VR are a realistic option for a some men.
There seem to be several sub variants of vasovasostomy for pain that don’t address fertility as part of the outcome. In some cases, the vasovasostomy methodologies are quite contradictory or completely different than one another. The methodologies I have seen posted on this site are completely different in comparison.
In some cases, the hemoclips and scarring is removed from the proximal end of the vas. In other cases, the hemoclips are not removed. The amount of scarring removed from the proximal end of the vas varies significantly, and so on. To accomplish this, in some cases, tricks are preformed on the proximal end of the vas that don’t get brought up often, if hardly ever, on this site.
One example - there is a variant of vasovasostomy that is known to be used by a respected PVPS reversal surgeon that I have only seen described once in 10+ years. It was posted on this site several years ago. Prior to those perticular post/s, I was completely unaware of it. At this point, I have not included any direct reference to that information in this thread. If you are interested in learning more about this particular sub variant, you will find those posts.
A bit about pain relief statistics.
Given everything I have said up to this point, I find it interesting and a bit odd that a handful of respected PVPS VR surgeons in north america site success rate statistics that are very similar to one another. All of them are doing their vasovasostomy’s a bit differently to some extent. Some are doing them considerably differently, and some are doing them completely differently than one another. How is this possible? How are they all siting and achieving similar pain relief statistics? My best guess is - that answer is hidden somewhere in the details.
Pre screening men or the intellectual lead up to a potential VR should involve many things I have previously addressed. But the kicker is - generally speaking, that’s not the case. If you understand everything I have previously addressed, you understand that pre screening and intellectual lead up to a potential VR may be of some value regarding what variant or version of VR may be better or best for you, not what version is better or best for the next guy.
Please also understand that a considerable amount of the stuff that I previously addressed is happening in the world of VR for fertility as well. Such as - what is being removed, what is not being removed, what gets mucked around with, what doesn’t get mucked around with, tricks, etc. When you get a clear view of what is going on within the big picture of VR for fertility alone, it will make your head spin at least once.
I have heard all kinds of rationale regarding my last paragraph at minimum, but it’s difficult to understand how there can be so many completely contradictory discrepancies within the same field of work. Everyone seems to think their methodology is the correct one, the best one, the safest one, etc. Really?
How can a highly experienced tried and true hand reversal surgeon that is on top of their game, has specialized in VR specifically for decades, is known to get it right the first time by taking their time and only preforming one reversal a day, takes pride in being regarded as one of the best hand VR surgeons in the world, has helped men with pvps for well over a decade, etc - all to have their methodology corrected or dismissed by another PVPS VR surgeon, or other specific fertility VR surgeons? WTH is going on here? How is this possible? Is anyone truly correct? Is there really a completely right or completely wrong answer? I do have my own opinion on this matter, but I’m not thinking there is a one size fits all answer. Whatever the case, I digress.
Please note that highly experienced VR surgeons that specialize in VR only and only do one VR per day seem to be far and few in-between. It seems that the majority of VR surgeons specialize in multiple urological surgical procedures, not just one. They are also commonly known to preform multiple procedures in one day. Who would you trust or recommend to do such a task when experience level and the alike seems to be key to specific aspects of VR? I am sure that many of them are well qualified, but you must decide for yourself.
Some of my last thoughts for today involve the statistics regarding how many men are made worse by VR.
There are a few different ways to look at how many men are actually made worse by VR. One must start by considering a few different things - including the time frame of more pain post VR, different or new symptoms, the severity, and so on.
I have seen testimonials from men that were definitely made worse by VR that made a near full recovery over a period of years after the fact. The data is limited. There are a variety of reasons as to why the majority of men do not continue to update their stories online. It’s impossible to know what happened to everyone that claimed to have been made significantly worse that simply stopped posting updates.
One must also calculate the idea of proper pre VR screening that includes trying to weed out men that a specific variant of VR doesn’t seem to fit their bill, if any of them do.
Doesn’t seem to fit their bill, might not have any effect on them, won’t have any effect on them, or it could make them worse are completely different things. It’s all a roll of the dice. I’m absolutely certain that there are men with PVPS that are not good candidates for any version of VR, but statistically, I have no idea how many men are not good candidates. I think some common sense will go a long ways regarding who is a good candidate and who isn’t.
Generally speaking, in pain forums like this one, the majority of men would not refer to VR surgery or the recovery as a walk in the park. There does seem to be a time frame that the majority of men seem to fall into. All at the same time, there doesn’t seem to be a one size fits all answer. Results certainly vary man to man.
I have seen all kinds of supposed typical, yet contradictory post VR for pain time frames regarding when the man should start to see improvement, when they should consider moving forward with something else, and so on. Such testimonials regarding typical time frames have been posted by members of this site straight from the source/s.
Over the last decade+, I have seen countless examples of why a man should consider waiting longer than what was recommended to them by their in perticular PVPS doc post reversal. I have seen countless men make significant improvements well beyond what was told to them by their PVPS surgeons. I have seen countless men get better or make significant improvements in the ~6-18+ month post reversal time frame.
Based on what I have seen, the ~6-12 month time frame seems to be more typical, but it’s not a hard fast rule. Some men hit their goals a bit sooner, and some men hit their goals a bit later. Whatever the case, in the majority of cases ~6-12 months seems pretty typical to me.
Obviously, there are or can be signs, predictors that a man is not trending in the right direction, and maybe he should reconsider all of his options. Including, but not limited to - waiting things out for an extended period of time. I’m certainly not a fan of anyone rushing into yet another surgical corrective procedure without exhausting concervative options, without giving your body plenty of time to potentially get it together, heal itself, etc.
Generally speaking, I try to encourage men to wait things out post reversal and stick with concervative options, etc - because I have seen to much. It seems that anything is possible.
Statistics, regarding what the actual PVPS VR ~authorities have to say regarding how many men are made worse by VR…
I have heard all kinds of stuff. Some say things like - nobody has been made worse. Some say it’s extremely rare. Some site the contraversial 1-2% AUA statistic that is associated with vasectomy. Considering everything, it’s hard to know what the actual statistics really are. Obviously there are inherit risks that come with any such surgical procedure. I think some common sense will go a long ways regarding this aspect too.
Assuming you digested everything I have said up to this point - given what I have read, seen, and heard over the last decade+, the number of men that are made worse in the long run seems to be quite low. But, that doesn’t mean that you won’t be the first, or that it can’t or won’t happen to you.