Welcome, unfortunately, to the group. My opinion (not fact and others may disagree) is that pain from the very outset of the vasectomy is likely neuropathic. So, I’m inclined to agree with your urologist. That said, if the nerve blocks haven’t worked, that complicates matters.
One question: who did you blocks? Reason I ask is that I’ve had two surgeons complain to me that Pain Mgt. specialists seem to pride themselves on how little serum they use during nerve blocks. I got very little relief from the pure GF and II/IH blocks from Pain Mgt. My guy explicitly told me that because he’s so good at hitting the nerve, he uses “less than a spoonful” of numbing agent. I thought that was good, but now I believe differently.
Also, like you, I got very little relief from PRF of the GF.
Not giving up, I had an in-office block done by a peripheral nerve surgeon, first of the II/IH and then the GF, and the GF block totally worked. Pain and sensitivity were gone. In fact, to confirm, we repeated the exercise after the anesthetic wore off, and I got the same result. He suggested a GF neurectomy higher up than SCD but he then referred me to see a different surgeon since he also found a hernia that he’s not able to operate on (as a plastic surgeon)
When seeing the second surgeon about GF neurectomy, I got the same result. Both of these surgeons used several vials of anesthetic, the second also with steroid. Since that last injection, nearly a year ago, I’ve been substantially better and put off surgery.
I had the same positive experiences with cord blocks which block the GF and II/IH as well as all the peripheral nerves in the cord (branches off them) as I understand it. I’ve gotten good relief from cord blocks done by two different urologists, one in Orlando, one at the Cleveland Clinic. I was set to have SCD but wanted to explore neurectomy as an option.
My point - based on my own injection experience and words of two different surgeons, I won’t use Pain Mgt. injections as a basis for decision. So, it’s possible you have II/IH and/or GF neuropathy, but they’re just missing the mark or not using enough agent.
I’m not so sure about your urologists reasoning. Can they provide you with any statistics regarding their statement about reversal?
There are other reversal specialists that work with pvps guys regularly that would likely disagree with your urologist up to a certain point.
Could a nerve be entrapped somehow? Burnt and/or cauterized? Perhaps an improperly placed hemoclip or even multiple hemoclips on a your painful side? That is unorthodox, but we have several guys on this site that can prove that was a finding post reversal. Perhaps a single hemoclip that landed on a nerve? There’s a lot to consider.
Pain from day one does limit the possibilities down substantially, but it doesn’t = x-y-z. Pvps is to trivial. If it wasn’t, people wouldn’t be asking so many questions, switching urologists, getting fed up, throwing the kitchen sink at it, etc.
Nobody has ever done a count on this site as to how many guys got zero relief, a couple hours or days of relief, made them worse for some time at minimum, gave them a hematoma, a combination of any of those things, and so on. The hematoma count alone is a substantial number.
I’m telling you now, this site alone definitely has a mixed bag of results from a simple cord block. Many would not do it again. Furthermore, there’s at least two men on here that claimed they ended up with a hematoma post cord block, and believe that is what caused them what they refered to as nerve damage. One of them posts was made less than a few months ago, and it seems they claimed it disabled them too. I don’t recall the username - I’d have to look for it.
Ultimately, all things that involve needle’s and knife’s are a roll of the dice. Heck, the same can be said about prescription meds. Some people end up permenantly damaged by them too.
If I had a recommendation, which I really don’t, I would advise you to speak with at least one person that only does reversals for pain, and does a lot of them. Or, at least get some input from other urologists that can do multiple procedures that deal with pvps guys regularly. I will not recommended anyone because anyone I may recommend could be wrong with their ideas, assumptions, game plan, etc. I certainly don’t want you blaming me for my recommendation. And remember, shit can happen anywhere, and I mean anywhere (emphasis).
BTW, I’m not trying to scare you. I’m just being straight up with you.
Ringo points out the complexity which is 100% correct. Back in 2006, after a few months of my initial bout of PV pain, I had a GF block. Got a little relief, not much. I DID have granulomas on the vas tips. PVP doc (not vasectomist) suggested reversal. No forums back then, so I rolled the dice and, after a 5-6 month recovery, I strung together nearly 10 years pain free except for a 6-month relapse 2008-09. In addition to the pain relief, my PSA and T-levels returned to normal. Reversal Doc said I was leaking from the vas tips.
Fast forward to my latest bout of scrotal pain that, after working at it, pretty much pinpointed the GF as the culprit.
Looking back, it’s hard to say what form of PVPS I had and what actually helped. No doc has put forth a theory, not even the reversal doc. Mostly, they say we don’t know.
I believe closing the leak and re-establishing flow enabled the PSA and T to return to normal. I also believe that the granuloma removals as part of the reversal helped with pain relief. I also think that the reversal did some further damage to my GF which gave way 10 years later.
Such a tough call for us all. I’ve been more fortunate than others on the board here. I got good results from reversal and never had complications from the numerous injections I have (over 10). That probably makes me a bit too eager to tell others to roll the dice.
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In hindsight - in regard to my quote above - I wish I had elaborated a bit more about the members on this site who did not report any significant complications from a cord block, nor from other various types of blocks. I have thought about posting an estimate, but I will not post a guess. Whatever the case, the things I pointed out are legitimate, and people need to be aware of that stuff. Don’t take my word for it - fact check my statements.
I find it interesting that people can take what someone said 2-3-4+ years ago, and assume so much. Many of us have grown on many levels over time. I certainly am not the only person on this site, nor in the field that promotes reversal for pain either. I do not hyperinflate the statistics regarding reversal. I just make sure people are aware of the option. I do not hyperinflate the possible recovery timeline either. I am straight up with everyone about it, and always have been.
I have always tried to warn people. Many of us feel we were lied to, sold short of the facts, and so on. I don’t try to talk people out of things, and I don’t encourage them to do anything specific that carries significant risks either. I try to keep one foot in, and one foot out in many topics. I make an effort to let people make their own choices.
If people come here, and post something in an attempt to get someone to encourage them to go one direction or another - it’s unlikely that I am going to entertain that idea past a certain point. I have been at this to long, and I know better. Many ask me specific questions, or even look for encouragement to do something via PM - and I tell them the same things.
There is one imperticular member on this site that had a bad reversal outcome. Obviously there is more than one, but in his case imperticularly - I clearly pointed out some fact checks regarding what he and several others were being told beforehand - I recommend conservative treatments first - I warned them on the open forum in several threads about many things many times - and after the fact, I clearly remember telling him - I will be more blunt with my warnings from here forward, and I have done exactly that.
It is not my job to constantly repost warnings either. If I previously posted warnings in a specific thread, don’t expect me to keep warning in the same thread over and over - or in every single thread for that matter. If people don’t read entire threads, or don’t read much here period - that does not fall on me, or anyone else for that matter.
I hope you didn’t take what I said wrong. I’m telling you brother - we really do see a lot of that kind of stuff here - and that’s ok. We see it from average people, laymen, experienced veterans, individual urologists, individual pain management specialists - etc.
Those kind of things are certainly not worth arguing about - and so on. People need to do what they think is best for them. I find that in to many cases - and on many levels - what works for one, may not work for another. That includes opinions, thoughts, treatment protocols, your path, my path, his path, and so on. That’s ok too.
We have guys on this site that have made statement like - I wish I had tried something else first - I wish I had gone somewhere else first - I wish I had knew more about what I was getting myself into beforehand - and so on.
I’m always here to help where I can, but people can expect warnings from me. I feel I have a moral obligation to make people aware of significant risks and/or complications more than anything else. Anyone can fact check that statement. My warnings can be found all over this site.
Regarding de-nervation of the spermatic cord (SCD) - it has a bad reputation on this site. That’s not to be confused with the idea that it never works - nor that it is not a viable option. I generally do not comment much in such topics anymore. Such procedures carry benefits and risks of there own. Furthermore, the statistics for pain relief vary surgeon to surgeon. Should you choose to have such a procedure - please make an informed decision for yourself beforehand. And if you choose to have such a procedure - for better or worse - please post some feedback on this site.
Bottom line - we as a community want to see men get better. We don’t care how they do it. We don’t want to see anyone end up in a worse predicament either.
Your path, my path, his path, and so on - it really doesn’t matter. There is no one path for every man. We are all responsible for our own choices, and we all blaze our own trails.
Ringo is right that SCD does have negative perception on this forum. Anecdotally, I’ve read more guys discuss their failures or non-successes than successes. That said, it’s also feasible we have a biased population. I think men with success tend to move on with their lives. Plus, I’d venture a guess that we represent a minority of PVPS sufferers and an even smaller minority of SCD surgeries.
I credit this forum 100% for saving me from going for SCD. Maybe it would’ve worked, maybe not. But, because of the mixed bag (and Ringo is right, it’s at best a mixed bag here), I saw two different, well-known uros who perform SCD. Both confirmed I was a good candidate but, there again, the ol’ adage of “if your only tool is a hammer, the world looks like a nail” comes into play.
I pursued examination by two different surgeons for triple or simple GF neurectomy. I think everyone considering SCD should also consider this. There is, to my knowledge, only one uro nationwide doing both SCD and laproscopic neurectomy, and he sees neurectomy as more radical and a last resort, but others see it as a more durable solution.
Something we need to understand is whether SCD is simply a good solution for non-PVPS scrotal pain but a coin-toss for PVPS victims. We see uros publishing remarkable results for SCD, but they aren’t born out by PVPS victims here.
Lastly, here’s my logic about injections and pulsed RF (done with a solid needle). I favor them as the lesser of evils. Yes, they’re risky, but a scalpel can do a lot more damage than a needle. In addition, I personally have become VERY skeptical of the ingestible medications PVPS victims get prescribed. On this forum, I can’t think I’ve ever seen someone who attained remission from pain through gabapentin, cymbalta, amitryptiline, etc. but I’ve seen many reports of negative responses due to their impact on the CNS.
Give me a needle with meds being deposited right at the pain source over a drug that impacts my entire body 7 days a week and twice on Sunday. Again, that’s my personal, non-medical opinion.
Amen to reminding the community about the risks associated with pharmaceuticals. I was so desperate I was taking anything and one med was cyprofloxcin. Adverse (not super uncommon) side effect is it eats away your joints and specifically Achilles joints. That was almost a year ago and I’m still very bothered by my Achilles tendinitis today. NSAIDs are also really hard on the gut. I know when you’re desperate you don’t care but that can come back to bite you too.