Post Vasectomy Pain Forum

Ilioinguinal nerve block - Pulsed radio-frequency

I’m now booked in to have a ultrasound-guided pulsed radio-frequency ilioinguinal nerve block while I wait for a right side orchiectomy.

If the nerve block works, then I wont need the testicle removed, but what if the nerve block makes things worst?

Do I go straight for removal, or do I try the nerve block?

Do you have a diagnostic injection or a pulsed RF treatment? I assume what you mean is you’ll have pulsed RF on the II if the diagnostic block works.

A pulsed RF injection with ultrasound guidance.

Did you have diagnostic blocks before? Left/right? II and also GF?
Did you have such a treatment (pulsed RF) before?
Was pulsed RF offered to you, or were there also alternatives (RF, botox, cryo,…)?
I am at a stage considering these treatments, too.

Very unlikely a block would make you worse. I’m not sure I’d worry about that. I’ve been giving nerve blocks 12-15x a day for the last 14 years. With the exception of a little post op soreness, I’ve never seen an issue. Good luck

I once read that injecting into the ilioinguinal nerve can sometimes damage it, which then triggers more pain???

I dont think my pain is being conducted via the Ilioinguinal nerve, I don’t really get pain in the abdomen or inner thigh, no burning pain. My pain is in the testicle itself, top and bottom of testicle and the pain goes all the way down my right leg into the top middle of my foot.

My surgeon said that the surface of my right testicle is inflamed, he reckons I’ve had a previous infection which has damaged the tissues.

The pain clinic has offered me the pulse radio frequency nerve block, but I cant see it working, I don’t reckon it’s the llioinguinal nerve that is being affected, seems a waste of time having the block, I don’t fancy mucking something else up.

I’m more inclined to go straight for orchiectomy, just get rid of the damn thing.

Anything is possible I guess but it’s extreme difficult to damage a nerve with a 25 or 27 gauge needle. The anesthetic is pretty benign too.

I certainly wouldn’t go through with the ablation without first trying a diagnostic injection. Get it numb and see if your pain disappears. If it does, you’re on to something. If they anesthetize and the pain remains, keep searching. Diagnostic injections can be very helpful in the right situation.

I had a hydrodissection of my GF nerve two weeks ago. Simply getting the GF nerve numb brought my rectus abdominis alive. I was able to do a sit-up without pain in years. My SIJ pain has also improved since then but I think that’s more the hydrodissection than the anesthetic.

Start with the least invasive and work your way up.

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Yeah thanks Choohooo.

What is a diagnostic injection?

Last year I had a llioinguinal nerve block without pulse radio-frequency, I didn’t feel any relief until the 5th day, my pain reduced from 9 down to say 2, but I’m not entirely sure it was the nerve block that worked. I can get a few days when pain is at a low level anyway, so I’m not entirely sure the first nerve block I had actually worked or not, I didn’t get any relief when the injection went in.

A diagnostic injection is just that. Get it numb, see how it feels. The problem is finding the true source of the pain…is the pain from the nerve or what the nerve innervates?

I’m a dentist. If you have a painful tooth, I numb the nerve and the pain goes away. Does that mean the nerve was the problem? Not necessarily, it was the tooth. It’s a tricky cat/mouse game trying to figure out the root cause of your pain.

PVPS sucks.

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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.

Bravo @Chip5 Let me be the first to bestow upon you an honorary MD degree in urology. You already know more than both my vasectomist and the poor uro I consulted with a month later who didn’t understand neuro anatomy of the scrotum.

I think it’s safe to say that no one has a clue what’s going on. That said, this is the nature of the beast with PVPS. It’s complicated. Your surgeon is correct in saying “they don’t know.” At least he’s honest. That will serve both of you well.

Did you have a vas or was this kicked off by a varicocelectomy? Honestly it could be either nerve and either can be damaged from surgery. You are correct in the the genital branch of the GF is within the spermatic cord and the ilioinguinal runs alongside it. It would make more sense to be the GF given the location and anatomy however with a vas, if there was collateral damage, it could easily be either nerve.

You also have the possibility of nerve crosstalk. Pathways aren’t as black and white as they should be.

To answer your questions. Will the nerve block work? The answer is emphatically yes but I don’t know what your definition of “work” is. They’ll always be able to get you numb but that’s literally all they’re trying to do. Numb it, see what happens. Did my vas work? Yes, I’m sterile, but now I can’t walk very well. Did it work? The block most likely won’t fix your problem, its simply used as a diagnostic tool to try and figure out where the pain is coming from in the least invasive way possible. If I were your team, I’d block one and see what happens, if no response then block the other and see what happens. I’d compare it to the breaker box in your house. If the lights are off in the kitchen, start flipping switches in the breaker box until you figure out which switch correlates with the problem.

I really hate to be the one to recommend removing your testicle but I will say I wouldn’t fear it. We have two for a reason, losing one isn’t the end of the world and there’s often some compensation that takes place from the other side. I would gladly and proudly donate my right testicle to science if it would fix me. I will add that I don’t have much testicular pain but I do get pain from the two epididymal cysts I have on that side. This was there pre vas.

Testicles, epididymis, tunica vaginalis, these things are all so microscopically complex that unfortunately there aren’t many answers or options out there.

I bought a new pair of jeans at the weekend, I put them on and within seconds I’m in agonising pain, so took them off and pain subsided to a dull ache, its crazy why this happens.

Can’t wear jeans myself. Any pants that cause pressure start a flare up. Unfortunately draw string ‘comfy pants’ are what I have to wear everyday. Days I have a meeting or into the office are the worst but I think it’s partly the dress pants I have to wear.

Maybe go back and try the baggy JNCO jeans I wore in the 90’s!?!

All kidding aside, that sucks. However, I’ll go out on a limb and say that your pain is so specific and localized that I’m confident they’ll be able to do something for you. Even if that means orchiectomy, you’ll find something that works. It’s the non-specific cord pain that seems to be the tricky one. If it were me I’d tried to avoid all the silly ancillary surgeries like SCD, epididymectomy, etc. but that’s nothing more than my opinion

So true so true, top and bottom of epi is the trigger point, touching the head or tail is like turning on a switch. If I walk around with nothing on or stay in a pair of joggers, I get no pain at all.

I’m due to go and have the llionguinal pulse radio frequency next week, but I was thinking of cancelling and just wait for my the orchiectomy appointment to come through, just get rid of the damn thing. My uro surgeon said he wouldn’t just remove the epi as it will cause me more pain, just remove everything he said.

My right epi has a cyst, plus the surface membrane of my right testicle is inflamed, so I guess these are red markers as to why I’m getting pain when something touches my right testicle.

I want to try the pulse frequency nerve block, but I don’t want it to damaged the Ilioinguinal nerve, as the Ilioinguinal nerve will be left behind after orchiectomy.

I remember those baggy jeans from the 90s. Thought I was so cool in them haha.

Hi guys. I had the ultra sound guided radio frequency ablation procedure done yesterday, it was a quick and easy procedure which went well, they also injected a steroid.

I was achy after the procedure, my right testicle, leg and foot was giving me hell afterwards, the procedure aggravated the original problem, so this must prove the ilioinguinal nerve is playing a part in sending pain signals from my testicle and down my leg. The signals must go along the nerve to the root nerves in my spine and down my leg, I actually felt the electrical pulses go down my right leg and into my foot, it was a very strange feeling.

They used a probe to heat up the ilioinguinal nerve to 42 degrees and send electric pulses for 3 minutes, I had two sessions of 3 mins. I think the surgeon also said he also got the iliohypogastric nerve.

I’m not sure if it’s worked yet, but I don’t have any pain at the moment which is a good sign. I will know more as the days go by, see what I’m like as I do my daily activities.

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Thanks for the update, fingers crossed for you!

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