Post Vasectomy Pain Forum

Evaluation and Management of Chronic Scrotal Pain -- Dr. Amin Herati

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This is a really good presentation @Ethan_Scruples
Thank you for sharing!

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Thanks @Ethan_Scruples.

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Thanks Ethan I watched this (most of it - up to questions) and I fucking cried because I was let down so badly twice. First by my initial urologist who LIED to me about the probabilities of PVPS and then by my reversal urologist who should never have done a reversal without diagnostic blocks or probably at all, considering that my initial pain was not focused on ejaculation. I could scream.

Looks like my best bet now is to try nerve blocks and hopefully get relief without going down what seems to be a risky pathway of nerve stripping.

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This doctor and this video are both so impressive. It will be doctors who approach the problem like Dr. Herati that actually make progress on how to treat men with PVP.

I have some quotes from the video that I want to highlight when I have some time, but just off the top of my head, I noticed that he really seems to empathize with men who have PVP and treat it as a physical disease, like the cyst on his hand, without any shadow of an insinuation that maybe some of the problem is the man’s attitude. Certainly attitude matters, but even men with an optimal disposition have a significant problem and reduced quality of life if they have PVP.

He also seems to have no reluctance to criticize or discard “cures” that don’t work well or have downsides, like epididymectomy and MSCD. In particular, he doesn’t seem to be easily seduced by the desire to offer men a treatment just to have something to offer.

He seems to be approaching the disease with fresh eyes, especially focused on the neurological aspect of it, and coming up with new approaches for treatment. I liked his comment on why a lot of PVP cases complain about weak urination. Many of us probably attribute that to a swollen prostate that has gone haywire by some mechanism that we do not understand. This is the first time I’ve heard anyone talk about sensory problems at the bladder level.

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Interesting. I swear my bladder control has changed since my vasectomy. There are some days where I’m normal, and other days i need to pee almost every 1-2 hrs regardless of how much fluid i consume. I at first contributed to maybe being on TRT, but my PSA numbers are normal :man_shrugging:

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I think this should be recommended viewing for those new to the site. It acknowledges PVPS and explains it as it relates to the anatomy and in doing so familiarises the viewer with the anatomy, explains a range of different pain generators and emphasises the need for a thorough examination to replicate the symptoms to help guide treatment options.

I am just over a year into my own journey with PVPS now and this video probably would have saved me about 2 months of unhelpful ruminating and a further 3 months of my own research.

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I thought the video was pretty good myself, but everyone should keep in mind that we have countless men on this site that regret having such and such block/s done. The narrator didn’t talk much if at all about such statistics. I have heard horror stories regarding block/s that were done by docs that nobody would imagine did this and that to them during the process.

The narrator sounds like he knows his stuff and is good at what he does, but I assure you all that this is not typical across the board.

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Dr. Rosenblum talks about how he does nerve blocks in this podcast as I recall… Some guys just jam a needle in there. Others are using ultrasound. Nerves show up in unpredictable places. I’d say if you are going to get a nerve block you should go to someone who is really good at it.

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Had anyone on the forum received treatment from Dr. Herati?

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