Post Vasectomy Pain Forum

Is Dr. P opposed to radical orchiectomy?

Hydrocele surgery 2004
No complications for 16 years
Testicle pain started 9/24 with swelling of epididymis and sperm cord
Treated at ER on 9/30. Ultrasound normal, urinalysis negative, prescribed 10 days doxy
Doxy did not work
Treated by urologist 10/14. Prescribed Cipro. Had to stop due to side effects.
Treated by another urologist 12/29 with another 3 weeks doxy. No effect.
In pelvic PT from December 7 to present. Marginal effect on pain, zero on swelling
NSAIDs and gabapentin ineffective

There is palpable swelling and tenderness and cord of epi even though it is not visible on ultrasound. There is moderate pain 24/7. Pain is worse upon standing and sitting. There is zero radiating pain elsewhere.

I would like to go right to radical orchiectomy and go with a prosthetic testicle. By the time I’m ready it will be 6 months. I doubt the swelling is going to burn out on it’s own, I now believe this is pissed off scar tissue.

With two surgeries now in this area I am not interested in the possibility of more complications. I have read about denervation and it is well outside of my risk appetite. I am not interested in preserving the testicle, I am interested in full 100% pain relief and since my swelling is localized, I do feel removing the entire right side is my best option. I want this similar to a testicular cancer removal - most of those men go on to live perfectly normal lives and are walking around in days.

I understand Dr P is world renowned and is responsible for the invention of a new robot assisted denervation, but I am still very unlikely to accept this, but I want him to perform my surgery due to this reputation and I’m in central Florida anyway. My question is before I book a $200 call how likely is he to push back or does he perform his client’s preferred method of surgery? My mind is pretty much made up.

Concerning Dr P - I would like to hear his opinion on radical orchiectomy after microsurgical denervation. From bits and pieces I’ve read, it sounds like denervation more or less excludes later radical orchiectomy, and that a subsequent orchiectomy would have to be done by scrotal incision?

Probably because denervation will create a weakened cord with lots of scar tissue, that is physically very difficult to pull out of the inguinal canal in one piece.

I haven’t looked recently, but Dr. P.'s former website at PUR Clinic listed a ladder of interventions that he offered, and they SEEMED to be in order of least invasive to most invasive. Injections, for example, were the first line of defense, and I believe orchiectomy and laproscopic neurectomy were last resorts.

Overall, while I THINK most uros including Dr. P. view orchiectomy as last resort, I think the good ones look at the history and evidence on a case by case basis. In other words, if you’ve had no surgeries, they might be more hesitant on orchiectomy than if you’re like me and already had a reversal.

So, no, I don’t think he will be reflexively closed to the idea of radical orchiectomy though I think he will offer other solutions.