Well, despite my optimistic posts several weeks ago, it appears the steroid/botox block has worn off and I’m back to baseline scrotal pain.
Quick background for newcomers to my situation:
Vas in March, 2005 (age 40), pain onset October 2005 after bicycling, reversal in 2006, pain-free from late 2006 until April, 2016 other than a brief 6-month battle 2008-09 that was overcome with gabapentin and celebrex. This 3rd bout also began after my first bike ride of 2016.
Since April 2016, I’ve had: II block (no benefit), GF block (some help), pRF of GF (some help), 2 blocks and pRF of pudendal (eliminated perineal pain entirely, still gone), 2 spermatic cord blocks with Dr. P. (major help…pain free a 1-3 months after them). Only short-term solutions to scrotal pain which is 95-100% left side. In fact, this last cord block was done only left side and my pain level was at 0 most of the time for 5-6 weeks so I believe that any pain I’ve felt on the right side is referred or “cross talking”.
I’m hearing the siren song of denervation or neurectomy: First, the supposed indicators (successful blocks) have always been favorable; Second, my pain is one-sided, isolated and concentrated above the testicle, I think the nerve damage is limited to the left cord, likely on branches of the GF; and, third, I’ve shot the wad on non-surgical interventions.
Dr. Parekatill has already confirmed me as a candidate for his targeted neurolysis based on my results of his cord blocks in 2017 and 2018. I can schedule that tomorrow with him but am leaning toward doing one more cord block with botox as a “booster” to the June block as my last-ditch non-surgical attempt. I have this booster block scheduled for 9/28 but will probably move to mid-October.
I’m scheduled to see my Cleveland Clinic uro on Fri 9/14. He is the only uro in Ohio who performs SCDs. He will, if I want, do a cord block in the office and, if it relieves pain temporarily, will do SCD. I’ve avoided this because I’ve been hesitant about blocks without general anesthesia. I don’t know if his approach or record is any better than Dr. P., but the two know each other and work together on research, and I’m comfortable with either one. For me, it’s a question of 20 miles vs. 1,200 miles.
I’m also scheduled to see Dr. Williams in Baltimore on Mon 9/24. He will do an II block and then a GF block. If either or both relieve the pain, he would perform a neurectomy (my term based on layman’s understanding). Different approach, but with its own set of risks.
Between 2006 and 2016, I developed lower-back arthritis and ended up with L5/S1 fusion. I totally believe @Acschiro and @Choohooo who’ve opined that a dysfunctional left GF led to core weakness and LB problems. I don’t believe, however, that the scrotal pain origins are in my back. BTW, that fusion has been a total success. My LB and leg pain have been gone 99% of the time since 2012.
I’m open to any and all opinions. Go, don’t go, go see another surgeon, etc. I know that denervation has a lot of first-hand experienced opponents here, but I can’t help but believe my situation is different (yes, I know I’m rationalizing) because of the 10-year gap of pain-free status. At the same time, I know that’s me talking myself into doing something rather than nothing. I also see the possibility of my pain being from a failed reversal as @RingoStar has logically suggested, but my pain symptoms don’t sound or feel like congestive pain. Never have. I’ve NEVER had pain in the testicle itself. In fact, reversal doc back in 2006 said I didn’t seem congested. Looking back, I think that reversal benefited me from the clean-up and removal of granulomas more than restoring patency.
Thanks in advance for any input.