Post Vasectomy Pain Forum

Bias towards reversal / denervation vs. GF neurectomy

I start to think that the proposed surgical “solutions” to PVPS, that are being discussed over and over again (admittedly based on research papers, mostly by urologists), are heavily biased towards reversal and/or MSCD (or targeted neurolysis, Dr. P’s approach), simply because the problem is considered a urological one, and affected men seek help from urologists, and that’s what they can offer.

I question, if one were unbiased, whether it would not be better to consult with peripheral nerve surgeons instead? I believe @raising4girls expressed some similar thoughts in one his posts.

Why not go to an expert for GF and/or II neurectomy and cutting these nerves higher up, after a series of cord blocks to be certain which ones are the culprits, instead of trying to risk a reversal or denervation in area heavily traumatized after the original vasectomy?
In case of the GF it will only affect the cremaster muscle, and I’d like to think I could live without it if I am pain free.

@Juno great point and something I think everyone should think about.

Ultimately Urologists will give you what Urology has to offer but I think when it comes to neuropathic cases I’d be open to get opinions of peripheral nerve surgeons.

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It’s the old adage of “if my only tool is a hammer, the world looks like nail” theory.

I think MSCD and reversal via urologists have their place but MIGHT be of no or limited benefit if nerve damage extends beyond the scrotum. I don’t know precisely how this occurs, but it appears from my read that damage to peripheral nerves like those in the scrotum can “travel” via the nerve sheath to the spine or other peripheral nerves. Again, I don’t know how this happens, but it appears from the evidence on this forum that there can be a cascading effect of nerve damage, that it’s not always isolated.

In these instances, urologists and their approaches may be necessary but not sufficient.

What if it’s difficult to figure out if it’s located only in the scrotum?
I’m so messed up, I can’t tell for certain. Sometimes I have pain outside of the scrotum and I’m not sure if it’s referred pain, depending on the meds I’m on, or something else. I definitely felt different pain when I was on Tramadol; it used to be more around the prostate than in the scrotum, now that I’m off it, it’s much more in the scrotum, but whether at the front (I guess that’s the II and/or GF) or at the back (pudendal), I can’t really tell.

It’s always hard to tell with pain.

I did have one peripheral nerve surgeon suggest that sometimes it’s best to try MSCD first since it’s more localized than neurectomy.

That makes sense. I think that would be probably be the case in my situation, that it’s more localized. I will hopefully be able to wean off of Lyrica completely, and then it should be clear.

I wonder if there is any stats or paper out there looking at the success differences between MSCD and a “mini-denervation” that automatically takes place when a reversal is done (and scar tissue is removed and/or the cauterized ends are newly cut), as one urologist put it whom I had a consultation with.

Near as I can tell, there’s no serious study with statistics, so we have to rely on the anecdotal evidence from a handful of surgeons. The PUR Clinic appears to offer all three major surgical interventions (MSCD, reversal, laproscopic GF neurectomy) so, at least with them, we can’t accuse them of seeing the world as a nail since they have more than a hammer. Same for the Cleveland Clinic here in my hometown…there, it just takes time to find the right person to consult. Those two institutions recently and jointly published some stats on the efficacy of MSCD because they’re considered the two “highest volume producers” which I found an odd moniker.

I’m seeing a pain management doc currently, instead of a urologist. My pain doc gave me a shot targeting GF, II, and IH nerves. But it didn’t do anything. I may try a spinal cord stimulator with him. So far, I’ve had better luck with urologists.

Might be worth seeing a peripheral nerve surgeon, too, like Dr. Williams at the Dellon Institute in Baltimore.

Well when shit hit the fan after blocking the vas maybe the idea of opening it again would be the solution? Nerve denervation is in my opinion removing the low oil warning bulb from your dashboard so you 're not running low on oil anymore.