I recognize the variability and the numerous factors that feed into this, but looking for general feedback /guidance from folks who have had a reversal. What’s the minimum amount of time one should wait and see before considering a reversal?
Doctor Daniels in SC will not operate on men that are within 3 months of their vasectomy, due to the fact that there is still healing and inflammation. I’ve heard guys recommend wait up to a year, as PVPS can improve over time; however, I got the ball rolling ASAP and had my reversal at around 5 months after my vasectomy.
I wish I did took me years to be allowed a reversal
Took me about 8 months between pain onset and actual reversal surgery, 16 months from vas to reversal (since pain started about 8 months post vas). Would’ve liked to have had the reversal a bit sooner but the vasectomist had me wasting valuable time running through a battery of tests trying to prove my pain was from something other than his hands.
If it were me, I’d try to wait at least 6 months before scheduling a reversal. Plan to have it done around the 8 month mark. That’s a solid enough try that I think the reversal would be appropriate.
I think this is very much dependent on your current pain and your willingness to be fertile again.
I got the vasectomy to avoid other forms of contraception and because my wife didn’t want to be on birth control any more. I’d take a life-time of condoms over 1 day of the pain I am in now.
It’s been the worst decision of my life to get the vasectomy. I’m in constant debilitating pain. No pain medicine will resolve the pain. It’s excruciating and has literally ruined my life.
I’d much rather try to get the reversal done now just because I’m literally going insane from the pain right now. I’m 4 months post vasectomy. My reversal is schedule for 5 weeks from now - which will be 5 months post . If I could do it sooner, I would.
My doctor did not properly disclose the risks. Insanity that this can happen in the United States without proper informed consent. Urologists are getting rich via vasectomies. They are like factories and they don’t care about the 1% to 2% of men who have their lives ruined on their way to record profits.
Insane is right.
The reason I did not do my homework before getting a vasectomy was that it was literally inconceivable to me that there was a common, horrible side effect that I had somehow magically never heard of, and that my urologist would gloss over.
I don’t think this is limited to vasectomy either, by the way. I had an MRI this morning, and I was a little concerned about the gadolinium-based contrast they would give me. I called a few days ago and confirmed that they are using the macrocyclic version of the drug.
Because I was already alerted to the issue, I was in a special position to watch how the tech brought up the subject. It was fascinating.
She brought out a checklist and mentioned that they would be using a safe, “water-based” dye that would leave my system in 24 hours, but they needed to confirm a few things beforehand. Then she asked various questions to confirm that I don’t have any health issues that would interfere with my body’s ability to clear the dye. Then my signature indicating consent.
If I had been unaware of the noise around gadolinium, I would have taken her statement at face value, and not seen the reasons behind the careful way the statement was crafted.
Basically, MRI techs have learned the same lesson urologists have learned. There is a way you can say things that leaves the door open for more questions and unhelpful tours through subtle risk analysis, and there is a way you can say things to hurry the person through the topic while nipping unhelpful questions in the bud.
In magic performance art this is called “forcing” a choice. In other words, the magician gets the participant to choose “of their own free will” the option that the magician has already selected for them.
Compare the rehearsed statement above with this rather unflattering version:
“You will be injected with a dye that contains a heavy metal called gadolinium. Most of the gadolinium will clear from your system because it is attached to a water soluble molecule. Some of it will remain in your brain permanently. We have not seen anyone have health problems from this, and we have been giving this dye for several decades now. If your kidney function is impaired, this dye could possibly result in Nephrogenic systemic fibrosis, a serious disease. So we’re going to ask some questions to make sure you don’t have any risk factors for this.”
They aren’t going to inform the patient. They have done the risk analysis, and they are going to tell you the answer of whether the risks are worth the benefits or not. This is pretty patronizing, but this is how it works. From what they told me, it sounded like they were probably injecting sterilized beet juice.
I did my homework, and in the end I accepted the risk because I want to know if I have a brain tumor. The standards for informing patients should be much higher for an elective procedure like vasectomy that is not done to treat a disease.
I agree with you that one of the most frustrating factors about PVPS is that it results from an elective procedure. Anyone with PVPS would prefer condoms or 10 more kids to the pain and other issues. If there’s a risk involved in a procedure that I will die without, so be it, lets roll the dice, but don’t gloss over the risks when something so unnecessary can ruin someone’s life.
I think many men would prefer celebacy to a vasectomy if they could go back.
I don’t quite agree on this. It’s true that trace amounts of gadolinium will remain in a part of the brain. It was discovered about 5 or 6 years ago, iirc. But, as far as I know, they haven’t found anything that suggests this causes symptoms or disease later in life. I can say for certainty though, that gadolinium contrast saves countless lives each year. A handful of patients worldwide have gotten nephrogen systemic fibrosis. All of them had end stage kidney disease, on dialysis.
As an insider in radiology, I can say that this has caused us to be much more restrictive on who gets gadolinium contrast and who doesn’t. These discoveries really made an upheaval in radiology.
Which is the opposite of what urologists do with vasectomy, where no new studies on pain or prostate cancer can change what’s already written in stone.
We don’t give contrast to patients with moderate kidney failure (the kind that patients don’t even notice they have themselves), even if we know that there has never been a reported case of NSF in patients who weren’t on dialysis.
I think that fear of harming the patient is actually too prevalent in radiology. For instance, I’ve seen people who’ve had an appendicitis burst after a week in hospital, it went unnoticed because they refused do CT (which would have seen it) because of the almost immeasurable and highly debatable risk of getting cancer from radiation. A burst appendicitis will often cause you problems later in life, a CT won’t. And, I have seen patients (many in fact) where cancer went unnoticed for longer than it should, because we thought the risk of gadolinium was to great for those specific people.
Yes, quite right. I overstated the case somewhat and want to emphasize that I do not see any moral equivalence in what the MRI tech did and what vasectomists are doing.
As you pointed out, there are several relevant differences, such as:
- Trace gadolinium is not known to cause disease
- Contrast enables correct diagnosis of very serious, even fatal problems in the person being treated.
- Recognition of the permanent change and potential for long term effects has prompted doctors to withhold the substance from at-risk populations.
I wondered if you would weigh in on this one @stk, given your background.
In sum, my point was merely that my MRI tech had learned the same trick as the urologists have to usher the patient to the predetermined choice through a scripted presentation that is intentionally designed to obscure facts that would provoke “unhelpful” or excessive deliberation.
I don’t say that to make a moral case against the tactic, really. The world is not black and white, and the average patient is not really mentally prepared to analyze these decisions as well as the trained professionals are.
Nevertheless it is worth retaining the informed consent of the patient as an ideal to strive for, and an acute awareness of the deep problems that can arise from trading away informed consent in favor of better health outcomes.
So I agree with what you say @Ethan_Scruples. The basis of it is - in a hospital or medical clinic setting, “informed consent” is almost impossible to practice completely.
When meeting with the health system, you have to in essence just trust their judgment, and that they know what they’re doing.
The example of contrast media is good. We don’t inform patient of all the conceivable side-effects and complications that may happen, and we don’t give them a risk vs reward discussion on why we do it. The decision to give contrast media is made by the radiologist, but he usually doesn’t see the patient, and rarely writes an explanation for why he thinks it’s necessary. So all the techs can say is “you need to have contrast, and we have judged that it shouldn’t be any risk to you”.
Some time ago, we had a freak accident with contrast. It was a CT, and for that you need quite a large volume of iv iodine contrast -in this case about 130 ml. This is injected from a machine - a pressure injector, because rapid flow is needed. Because the tech was sloppy, the iv needle was slightly misplaced. Some time during the injection the needle fell out of the vein, and the change in pressure wasn’t registered by the automatic system. the result was that a lot of iodine was pumped into the poor guy’s elbow tissue. This can be serious, there’s a chance of local tissue necrosis, and at minimum it means he’ll have a swollen painful arm and problem flexing his elbow for weeks. This kind of stuff happens, idk, a handful of times per year in a large hospital?
But it’s not a complication he was warned about, even though we know from experience that it’s possible. From his perspective, he was just going to have a routine exam with “no risk” and ended up with a massive problem and need for hospitalization. In the literature it says not much more than “might need consultation with plastic surgeon”, which is ominous. It’s not impossible he’ll end up a life long problem - a pain problem that when viewed from the outside could be though of as “nothing”, but from his perspective it could be as problematic as pvps. The techs has been taught that subcutaneous injections are "usually not a problem.
Things like this happens all the time in the health system. Things you’d never thought was any risky at all. The morale is I guess, that whenever you do something invasive - no matter how mundane it seems at first glance - there’s a risk of doing harm.