Post Vasectomy Pain Forum

Input on Getting 2nd and 3rd Surgical Opinions


#1

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:

  1. 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.

  2. 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.


#2

It’s hard to say what you got going on @raising4girls, I’ve certainly suggested this was a possibility, but it could be just about anything. Failure certainly isn’t the only thing that I think your issues could be related, or relevant to. Please don’t get it in your mind that I think reversal failure has to be the answer.

Given the success rates, and statistics regarding the versions of de-nervation you are considering, which is Dr P’s version neurolysis, and traditional de-nervation, it’s hard for me to encourage you one way or another. I know we have many bad outcomes, and/or testimonials on this site about both procedures, and that’s unfortunate, because statically, we should have more positive testimonials on this site given the statistics.

Encouraging you, or anyone else on this site far as what they should do beyond conservative treatments is simply something I do not want to be a part of, and everyone that reads my material knows that. I tell people the same stuff PM. The last thing I want to do is get involved in someone else’s bs, and have them blame me for my input, and/or advice. That’s simply not happening.

I keep seeing the dellon institute, neurectomy, similar procedures, etc being brought up on this site often, and even recommend, including by people that have zero surgical experience, and are basically newbies to this entire topic, and I know of nobody that’s ever came on this site claiming to be cured by these organizations, or anything like what’s being presented as “new options” for men with pvp/s.

I’m always here to help, so ask me specific questions if you have them.

Best of luck.


#3

You’re right about few success stories coming to this site yet we have several urologists touting high degrees of success including two whom I’ve seen and been treated by. One claims to have performed 2,000 SCDs with 80-90% success rates yet, as you point out, that’s not borne out by the membership here. One would think we’d see more cheerleading here.

It’s possible the stats of overstated. We’ve discussed that in numerous other threads, and that’s what drove me to try Pain Management approaches for over 2 years.

While taking the conservative road, though, I’ve also wondered if our group simply represents a small, tail-end-of-the-distribution fraction of patients. There are 500,000 vasectomies performed per year. If 1% develop chronic pain, that’s 5,000 men. Over 10 years, that’s 50,000 victims just in the US. My back-of-the-envelope math says this forum isn’t close having all 50,000 men with PVPS as members or contributors. So, while I agree with the skepticism, I also wonder if we skeptics have a sampling problem using the results here. I think it’s a distinct possibility (not probability) that many men do get cured with SCD or other treatments but we just don’t hear from them here.

Consider the possibility that I wasn’t aware of this new-to-me forum in 2016. I saw my regular uro at the CC in May 2016, he refers me to the SCD guy at the CC who does a cord block in his office, I have a favorable response, and I go through the SCD a few weeks later. It works! Voila, I never encounter this forum, I move on with my life, and this forum never knows about me. I realize that’ hypothetical is not proof, and I’m totally on board with the skepticism about SCD and urology in general, just saying that it’s possible that our forum anecdotes are missing many, many men.

Hard to say.


#4

Yes, it’s hard to say what’s going on. It was the same way on the yahoo forum which ran for many years. I could give a long list of members on this site alone that had a poor response to neurolysis, amongst other procedures. It’s really tough to say what’s going on in the big picture.

I notice that many people that seek treatment at a specific specialists office stop posting on here. My guess is they were advised by their doc/uro to not listen to any of us, what we got to say, etc like we were just a bunch of biased dummies. Idk :confused:


#5

I think it’s common for doctors to say “get off the internet.” Part of what’s driving me is that I had a HUGE fear of spinal fusion for my back problem. I was diagnosed for fusion in mid-2011 but didn’t succumb to surgery until December 2012. I got 2nd and 3rd opinions from surgeons all while trying every conventional, non-conventional, and dietary approach I could find. There are serious horror stories about fusion on the web despite neurosurgeons and orthopedic surgeons calling it a “gold standard” surgery. Heck, there’s even something called Failed Back Surgery Syndrome for those who get worse! People losing control of limbs, bowels, bladders. Scary shit. And, of course, there’s NO ONE posting positive stories on back-pain forums even though there are some (I’m one of them).

While fusion wasn’t denervation, my neurosurgeon DID decompress my nerve root. I can tell you that fusion is WAY worse of a surgery than reversal being one of the lucky humans to have had both, and SCD appears to be less invasive than both. So, my jaded perspective is becoming “hey, why not roll the dice, it’s not likely to get worse, you’ve tried everything else, and it won’t be as bad as 2012’s fusion.”

Only question, really, is whether to accept the hypothesis that a favorable block is indicative of a favorable nerve surgery whether via urologist doing SCD or peripheral nerve surgery doing neurectomy. Both groups seems to have positive testimonials on their websites if absent on this forum.


#6

I hear you brother. Hard to say what you will experience, or what your outcome will be if you decide to go down the de-nervation road. I support your decision whatever you decide. You’ve certainly gave all conservative treatments a fair shot.

Far as my lower back injury goes, it’s different that what you had, or have. A lot of misconceptions about back injuries, corrective surgery’s, etc. I won’t get into details, but mine is a soft tissue injury, and it’s deep. Combined with cartilage that’s no longer soft in some spots, a degenerative condition, I’m in a bad spot.

My wife did legal medical transcription for nearly 15 years, and back surgery was always coming up. I know of countless people that wish they could go back, and never have a back surgery because it made them worse on an overall level. Many docs say one back surgery will lead to two, and three, etc.

I was advised to never have a back surgery by a respected doc, and I’ve heeded his warnings since. Theres always the surgeon that has some new breakthrough procedure they claim will cure the worst of the worst. I know of a guy that had such a procedure several years ago, and he committed suicide not long afterwards because it wasn’t a success, and perhaps further injured him. I don’t know all the details, but the surgery was supposed to prevent what ended up happening to him.


#7

If your pain is in the part of the cord which is removed with a radical orchiemectomy would you not consider this over scd. Have you asked about this option instead of scd?, Id think there is less risk of something going really bad but im only going on the outcome of scd which the guy jesse had on here and wishes he went for a removel instead.

My gut feeling, and i have nothing to really back this up is its better to remove it than to mess with the nerves. Really what im trying to say is if I had to take a gamble, there is less chance of something going really wrong with a removel over a scd.

In your situation its a hard call as you have said pain is not in testicle itself. As for me I pinpoint pain in testicle and feel its already damaged from last surgery.

On another note if scd is so great as the numbers suggest is would be a more common go to for surgeons throughout here in uk…nhs here have loads of men like myself with testicle pain and it isnt even mentioned its very strange.


#8

I think your examples (and mine) demonstrate why 2nd and 3rd opinions are necessary when considering elective or corrective surgery. In my experience, surgeons are talented and confident, rightly so, but can be overconfident. They are also rolling the dice with you without having to handle the outcome.

I’m contemplating a trip to Chicgo to see Dr. Levine (on top of the 3 other experts I’ve seen / am seeing) for a 4th opinion for that very reason. But, in the end, if SCD is a total coin toss and the stats here disprove the optimism shown by urological pubs, then I guess it doesn’t matter how many I see.


#9

I don’t see where that’s going to hurt you in the long run. Might be the needle in the haystack you’ve been looking for. Hard to say.

I’m planning on seeing another expert in regard to my back sometime in the future. Seems every 5~ years or so, I go through all the hoops again, have another lower lumbar MRI, compare images from the times before, etc. If anything is holding me back and having a major impact on my quality of life, destroying my ability to do what I enjoy doing for a living, effecting my everything, it’s my lower back.

My residual, intermittent pvp/s is on the back burner. I’m not bad enough to consider another pvp/s surgery.

Good luck man.


#10

Never hurts to talk with another doc. As you know each specialist you see specializes in different surgeries, so it’s apples and oranges. You can read good and bad results from all procedures on this forum. So I’d say go with whom you feel the most comfortable or your “gut feeling”. Did only the mega block in cord help or have other gf blocks higher up worked?


#11

The mega cord blocks have given me more lasting relief, both well over one month. They were April 2017 and June 2018. The last GF block, a year ago, had some short benefit (hours, not day) but the subsequent GF pulsed RF helped longer.


#12

Since the blocks do help and we’re spaced out pretty wide has anyone suggested doing blocks every 3-4 weeks for 3-4 months to try and break the pain cycle?


#13

Dr. P. suggested doing that but I’m not sure how practical that is since heading to Orlando every 3-4 weeks requires flights. The Pain Mgt. doc locally has not suggested that which, to me, is frustrating to me. In fact, he’s always hit me and then scheduled an OFFICE VISIT in 6-8 weeks which then adds another 3-4 weeks to get in for another procedure. If anything, I feel like he has wasted time.

I think Dr. P. would do it. Haven’t seen anyone else. Suppose I could talk with the guy that did my back injections but am not even sure if he does groin injections.


#14

What are your current thoughts about neurectomy vs. cord denervation? Clearly each has risks. I’m going to explore each of them but am interested in your opinion. Is what Dr. P. did for you recently considered neurectomy as is done by the Dellon Institute?


#15

Yes abdominal laparoscopic neurolysis. It was a lot easier recovery than the denervation was. Went in through three ports, felt fine after a week at most. Was an easy 4-6 week recovery from denervation if not more. Scrotum swelled and went black and blue. Less than after the hematoma from my original vas. I believe spedreds son had similar procedure by dr williams.


#16

@raising4girls I worked with my PM guy and told them I wanted blocks every 2-3 weeks and they accommodated me which has helped lower my overall pain level.


#17

Thank. Good suggestions. I just messaged my PM doc’s office to see about coming back in for a consult or if he could answer some of my specific questions regarding other treatments.

I think, being a PM doc, now that I’m contemplating surgery (which I mentioned in my message), I think he’ll pull out whatever ammo he has left. Problem is that the II and GF blocks and pRF haven’t really done as well for me as Dr. P.'s cord blocks. I think Dr. P.'s approach is all that works for me, so perhaps it’d be worth scheduling 2-3 sessions with him before year end. He seems so confident, however, in denervation that I think he’ll think I’m crazy for making 2 or 3 more trips when he’s got the silver bullet ready to fire.


#18

@raising4girls i hear you and been watching your story closely. I know you have been trying all conservative options. Since you have had periods without pain in the past maybe the consecutive mega blocks will calm down the nerves without trying a denervation. Even with denervation they will cut II, IH, and GF from my understanding just lower compared to neurectomy. Do they bury the ends in muscle to avoid neuroma? I want to know every step of this procedure and what exactly is done.

I had PRF about 3 weeks ago and jury is still out on if it helped. I seem worse in other areas but also better in usual pain areas. The blocks for me always seem to give relief. I plan to back off everything for a while and see how I feel. I have been way more active lately and seem better mentally.