I’ve been doing some thinking…
I also had a spermatic cord block in June, but it didn’t really work, I still felt an ache in all three areas, top and bottom of testicle, down leg and into foot. The doc did say it can be difficult to get the right area for the block to penetrate all the nerves in the sprermatic cord, but after 4 hours my pain got worst again, so I guest the block did have some effect until it wore off.
The surgeon did say the problem they have is not knowing which nerve is transporting the pain from my testicle and referring the pain down my leg and into my foot, as there are so many nerves that could be involved, but I guess all nerves that are in the spermatic cord are suspects.
The fact that my pain always starts at the top of the right testicle (head of the epididymis), the epi is the trigger point and is extremely tender, so I guess the pain pathway must travel from the epi and through the spermatic cord and up to the L and S nerve roots in the spine. My theory is the fact that the Ilioinguinal nerve is not in he spermatic cord, it actually runs along the outside of the spermatic cord, so I guess it’s unlikely the pain is being carried by the ilionguinal nerve, so I guess there is no point having the ilionguinal nerve blocked.
When I had the varicoceletomy, my surgeon found that the surface membrane of my testicle was inflamed, I think it’s called the tunica vaginalis. A bit of research mentions the genitofemoral nerve travels with the spermatic cord to provide innervation to the cremaster muscle, as well as the tunica vaginalis, so as my tunica vaginlis is inflamed, this could be sending pain signals along this nerve and upto the nerve roots in the spine. Plus any organ that shares the same L and S nerve roots will also be affected, hence why I get pain down my right leg and into my foot, something to do with the sciatic nerves that share the same L and S nerve roots.
So I guess my pain team should be offering me a genitofemoral nerve block instead of the ilioinguinal nerve block. What makes matters more complicated is the fact that my pain always starts at the head of the epididmis, and this is where I have a small epididymal cyst, the pain could be travelling through the spermatic cord from the epi using any one of the spermatic nerves, either the superior, middle or inferior spermatic nerves could be affected.
Plus then there’s the autonomic spermatic nerves, some of these nerves are in the blood vessels of the spermatic cord and the epididymal tail, this may explain why I get pain at the tail of the epi and why I’ve had some pain relief from having 4x varicocles cut and tied off, cutting veins also cuts some of these autonomic nerves that run through the spermatic cord.
Questions I have for myself…
Q1: Will a nerve block work, and if it does for how long, and what block do I have?
Q2: Do I opt for Orchiectomy? If I have a knackered failing epi or a damaged membrane around my testicle, then orchiectomy is the only answer really.