Post Vasectomy Pain Forum

Orchiectomy after 6-9 months of pain?

Hello. Due to chronic, idiopathic testicular pain, I may be looking at an orchiectomy by this summer. So far it’s only been 3.5 months, and we are exhausting a handful more options but if they fail, I may opt for surgery. It’s debilitating and I’ve been basically bed bound for months. I am in pain sitting and with every single step.

So far I have tried and failed:

  • Rest
  • Ice
  • Heat
  • NSAIDs
  • 2 urologists
  • Papaya seed powder
  • Antibiotics
  • Pelvic floor PT

My ultrasounds and urine analysis are normal.

I am still going to try:

  • Longer pelvic PT (another 3-6 months)
  • Chiropractor (only because we’re thinking this MAY be a bloodflow/alignment issue as my spermatic cord seems much fatter when I’m standing vs. lying down on my side. Also the tail of epididymis swells up at times but always recedes)

It’s also worth noting I had hydrocele surgery on this side in 2004 so it could be scar tissue.

I am heavily weighing my options. If I opt for surgery it will be only after 6-9 months of failed treatments. SO…

  1. Epididelectomy - Seems to be the most problematic. Almost a sure thing additional pain will come - testicle is still there and sperm is still produced, but nowhere to go without epididymis? Result pressure pain. No thanks.
  2. Microsurgical denervation of spermatic cord - Everything remains in place, but nerves in the cord are skeletonized. Supposedely an 85% success rate, but nerves grow back and the potential for pissed off nearby nerves creating referred pain scares me. No thanks. I’ve seen the horror stories here.
  3. Orchiectomy - Urologist says nothing wrong with the testicle so leave it in place, but this seems to actually be the least risky especially if they go in inguinally. A lot of men with testicular cancer go onto live a normal life with 1 testicle.

What has been the prognosis for those with orchiectomy? And how many opted for a prosthetic? I think I would just for sexual health and confidence reasons. Does it come with additional complications? Was your testosterone and sperm count normal?

I live 90 minutes from Dr. P and will be doing a consult with him at some point. He would do the surgery if I have it.

Thanks men.

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I did targeted denervation on my left side in June and the right in August. Minimal post surgical pain and it resolved 100% on the right and about 99% on the left, which I wouldn’t even classify as pain on the pain scale. My surgery was done in Austin, TX. by Dr. Parvis Kavoussi. He has published several papers on the procedure and outcomes.

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Glad you’re feeling better. Please provide another update in June. I think a lot of men would
Be interested in whether you got to a full year without complications as there doesn’t seem to be a lot of research on that

A friend of mine had an orchiectomy 20 years ago, and has lived a normal, pain free life. His problem was apparently hydroceles on that side that kept recurring, so he opted for an orchiectomy.

Has your friend mentioned how long time testosterone replacement therapy has affected him?

No. As you probably suspect, the topic was not discussed much. I had a vasectomy the year before I met him and had much pain, but fortunately resolved itself in about three months. I was shocked to have that happen, since the damn urologist said nothing about that, but even more shocked to learn about having a testicle removed for a vasectomy.

I have lost touch with him, so I can’t ask. Sorry.

Have you had a cord block performed yet? This is the primary diagnostic tool to determine if denervation treatments might be a viable option.

I am almost 6 weeks out from having bilateral MDSC surgery at the Cleveland Clinic with Dr. Shoskes.

The incisions are still pretty tender, but I’d say the surgery was a success. I had major, debilitating pain in both testicles for several years (tried everything you mention above, and then some, including paying for a reversal) as a result of a vasectomy.

Today, I’d say the pain on my right side is 90% gone, and the pain on my left is 50% gone. The left has lingering pain in the epi. I may look into Epididelectomy for the left side, or start with Pulsed radiofrequency treatment.

Having had the reversal and the MDSC surgeries, I can say that recovery takes 3x as long as they tell you, and you won’t know long term results for 6+ months.

I would recommend trying the MDSC or other targeted denervation (also look into Pulsed radiofrequency treatment).

Let me know if you have any questions. I definitely would consider the orchiectomy as a last resort only if these others fail to provide results.

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We have testicles just for " t" hormones. Othervise they are not important…( İ dont want more child. My wife cannot cary).
İ have three big fear with orchiectomy…
İf my current pain doesnt resolve after orchi…
İf i have New pains… Like phantom pain…
İf i lost sexual desire and orgasmic plesure…

İ have also a dentist friend. He lost his one testicle 15 years ago. He said he dont have any pain. But his t level is close to the botom limit. He didnt get t replacement … he had 2 child after orchi. He said his sexual life is normal… But i dont know what is a normal sex life. A Medical doctor couple friends said they have two sex in a month. For me, i have 15 sex in a month (i am 47)… …
.also orgasmic plesure is not same in every sex. İt depends on how much i have desire (horny??). Some days i just ejaculate without any satisfactory plesure. Some days i have too much plesure. İ think it depends on hormonal levels… İ dont know what to expect after orchi…

One thing I would like to know - which I haven’t been able to figure out after half a year of studying the subject: Is there a rationale to go for bilateral orchiectomy as the first surgery for PVPS? I have an impression from reading studies and stories, that inguinal orchiectomy has the highest chance of resolving pain. If you go the traditional route via reversal and epiddidydectomy, there seems to be a fairly high chance to end up with pain and needing orchiectomy in the end. Doing orchiectomy first could possibly lessen the number of years of pain. Yes, one would need lifelong TRT, but I’m not convinced that is such a bad thing.

Anybody with knowledge to enlighten me on this?

Found this article. It might be of interest to you.
Extirpative surgery for chronic orchialgia: is there a role?

@CB89 Hi buddy, I did reply on my other thread.

I had my orchiectomy 3 months ago for chronic testicle pain with no known cause, the scrotum being the trigger point when wearing jeans/trousers, the head of the epi was the trigger point.

However, its looking likely the orchiectomy has not worked, I still have the same trigger point in the scrotum, anything touching my scrotum triggers the pain which then radiates down my leg and into my foot.

The orchiectomy procedure itself was a walk in the park, I had no swelling and no bruising, just a mild aching with a tight feeling along the groin. As the days went by I started to get more of an ache/pain, post surgery pain I guess. I’m now 3 months on and I’m back to my baseline, same pain as before with the scrotum being the trigger.

I had a simple orchiectomy as my surgeon did not recommend a radical, radical is normally performed for cancer patients. Now it looks like I will be going back and having the rest of the cord removed anyway. I reckon my surgeon was just trying to spare me unnecessary cutting as radical is more invasive, I don’t think his theory worked.

Don’t be afraid of losing one nut, it really isn’t that bad. I still feel the same as I did before, still the same high sex drive, plus you cant really tell one nut is missing, having one nut hanging still looks like two nuts hanging, you just see a round scrotum. I didn’t want a prosthetic put it as I’ve read some horror stories where guys have complained about pain and discomfort, and then they end up having it taken out.

I’m due to go back in April to discuss what’s next, my problem may still be the cord or it may be the scrotal skin, nerves etc. I’m learning towards having nerves cut or having the whole scrotum and content removed, get rid of the whole trigger point.