Great question. A lot of guys develop congestive pain weeks or months after vasectomy. In my case, I’ve never had congestion or congestive pain.
My pain started in October that year following a bike ride. In retrospect with 15 years’ hindsight and discussions with 4 urologists, 2 peripheral nerve specialists and several PTs, here’s the theories of what happened.
Branches of the GF nerve inside the scrotum were likely damaged by the vasectomy. This GF damage also led to core dysfunction which led to premature erosion of my lumbar spine and lumbar fusion in 2012.
The bicycling was the “inciting event” that turned the damaged nerves on making them painful. The PUR Clinic discusses this as Wallerian Degeneration of nerves that takes time (in my case, 8 months) to erode.
At that time, denervation was newer than reversal, and my doc suggested reversal with excision of granulomas and scar tissue. While not congested, removal of the scar tissue was a “mini denervation” in PUR Clinic terms.
After the reversal surgery, my surgeon told me I was actively leaking from both vas tips and that I was loaded with scar tissue. He, other uros, and I all surmise that the scar tissue seen and removed didn’t include microscopic scarring of the delicate nerve fibers and branches of the GF. The remnant scarring caused the relapses in 2008-09 and 2016-18.
- The reversal was necessary, however, not for congestion but to stop the immune system response to sperm out in the open. In addition to being a source of on-going scarring, the leaks and immune system response likely led to my PSA skyrocketing to 4.2. Today, 15 years later, it ranges 0.6 - 1.0. Similarly, pre-reversal, my T-level cratered to 285-325 (two tests) as a 40 y/o. Post-reversal with no leaks, it’s been in the 650-750 range despite being 55.
Hope that helps. Might be more data than you wanted, but it’s taken me over a decade and numerous docs to put the pieces together.