@worship01 - I am 2.8 years post vasectomy. But yes, maybe it is just congestion and not blowout, how to be sure without opening it, I guess. Epi is definitely swollen and hard at the tail. Sorry to hear that you have additional pains. If both of us have genital (maybe pudental nerve) and sciatica related pain, there is some possibility that we may have issues with S2-S3 nerves (that both connect to sciatic and pudental nerves), in addition to possibility of congestion, or neural reflective pains. My genital pain feels like dull and burning pain. I will start papaya soon.
I just got back from visiting a local urologist (Dr. Douglas). He is in the same practice as the other urologist Dr. Matthews whom I first visited about 10 months ago. Dr. Douglas is the only one there who does vasectomy reversals, and the only reversal doctor in my immediate area that I can tell. Here are my notes:
He examined my testicles. Right side was fine. By feeling around he found the granuloma very quickly on my left side. He said it was at the base of my left epididymis, so that confirmed what the first doctor had told me 10 months ago.
He said the granuloma didn’t feel that big, and was not 1.6cm across like the other doctor said. He said he has felt larger granulomas on guys who have no pain at all.
He also located the site of my vasectomy, and he said it was not too close to my testicles. He said it was at a pretty standard position about 1" or so from my testicles.
He said he didn’t like open ended vasectomies because they all close up / scar over within a few weeks anyways and carry potential for painful granuloma at vasectomy site. As a side note he said of one guy whose open ended vas adhered to the skin and every time he ejaculated some sperm would drip out on his skin… that is one was to do it. lol
He usually does just a small incision for reversals, but in my case he’d take the left testicle out to examine it and see if granuloma was accessible and could be easily removed. If not, he would likely leave the granuloma in there since he wouldn’t want to jeopardize the reversal. He said epi is delicate and trying to remove granuloma could impact blood flow to it and he would then have to take out the whole epi.
So he would do a vas-vas connection and hopefully the pain would go away (if it was due to congestion). He said it was not likely the granuloma would go away on its own, but that if my pain was due to congestion then reversal would resolve the pain even if granuloma is still there.
He said vas-epi connections are not as good, due to mismatch in sizes of the tubes and paper thin walls of epi. He said you can see the tubules of epi through the walls of epi. I didn’t ask him outright if he does bypasses, but it sounded like he was most comfortable with standard vas-vas.
He said insurance would cover removal of granuloma, but likely not cover the vasectomy reversal. They definitely would not cover vasectomy reversal for fertility, but for pain he said they might cover a reversal.
He said about 99% of reversals he does are for fertility, and he only does ones for pain every couple years.
Reversal cost would be about $7,000 total ($2,500 surgical feee, $3,500 for hospital fee, and $1,000 for anesthesia).
He said another ultrasound isn’t needed.
He said to let me know if I want to move ahead with reversal. He said odds are 75% it would get rid of the pain.
So my thoughts on what likely happened…
My open-ended vasectomy likely closed up and ultimately the backpressure caused blowout in tail of my left epi. My right testicle/epi is larger so perhaps was able to handle the congestion better.
So obviosuly I must have had some congestion of sperm for it to cause a blowout, but my gut feeling is that congestion is not the main cause of my pain. My feeling is that the granuloma is causing the pain, probably like this snippet below says.
(taken from: Testicular Pain Following Vasectomy: A Review of Postvasectomy Pain Syndrome)
At this point I think precision surgery to remove the granuloma and reverse the vasectomy at same time would be next logical step. My feeling is that an experienced reversal surgeon with operating microscope would do a better job of removing the granuloma without damaging the epi than a general urologist could do. Also, the reversal surgeon would also have interest to keep the epi intact so that reversal could be accomplished. I would want to make sure that they would remove the granuloma first before checking for sperm in the vas, in case granuloma was blocking the vas (not sure if that is possible, but makes logical sense to me).
Another thing I just thought of. About 6 months before I starting noticing pain problems my wife and I started taking Maca root to increase energy / vitality, etc.
But I just read studies that it can also increase sperm count. That may have been a contributing factor to me having a blowout on one of the side. So please everyone avoid Maca if you have a vasectomy…
I just spoke with Dr. Russell in Ohio on vasectomy reversal for about 20 mins. Very pleasant guy to talk to. My notes (in my own words of course):
- He asked some general questions about when my vas was done, what kind of pain I had, etc.
- He asked about my fertility before the vas, how many kids and goals for the reversal (pain only or pain and fertility)
- He mentioned the different surgical alternatives (reversal, removal of epi, scd). He mentioned that epi removal carries risks since epi is where the nerves and blood supply go into testicle, so potential to damage blood flow to testicle.
- He said that pain spikes with sex are highly indicative of congestion. And that in cases of congestion that reversal had a 80-85% success rate to eliminate or greatly reduce the pain.
- He said that nerve related pain usually manifests all the time, so reversal had only 50% success of curing the pain there.
- He said that it was 90% chance of not having to do a bypass since I was only 3 years out
- He mentioned if i was on testoserone then it could impact sperm, so would need to stop prior to reversal. I told him no, but I mentioned papaya seed I had been taking and that I’d read it had reduced sperm in animal studies. He didn’t seem familiar with papaya seed, but didn’t completely discount it either. He said that testoserone would likely do better job of reducing sperm.
- For pain patients he would try to remove any scars/granulomas he can see or feel. For fertility patients he would not unless they were in the way of the re-connection.
- I asked about blowouts and granulomas, and to my surpise he said blowouts do not cause granlomas, they cause blockages in the small tubes internal to the epi as I understood. He said blowouts don’t typically cause pain since the tubes are so small in the epi.
- He said he has not seen one granuloma on the epididymis in the 14 years he has been doing reversals (~4 a week). He said most likely it is just leaking from cut end of vas.
- Follow up seems important to him. He would do sperm test at 6 weeks, and then every 10 weeks. He would prescribe prednisone / aleve if needed to reduce inflammation and prevent premature scaring up of the reversal. Some pain patients do not want sperm checking once they are pain free and he would respect that as well.
So I am totally confused now, and would appreciate any advice from the forum.
I just heard back from Dawn at ICVR, as I had asked if she could please check with Dr. Burrows if he had every removed a granuloma from the epididymis before for his pain patients. His response was that he didn’t know what an epididymal granuloma was, and he had never seen it before. He said granulomas form at the vas site, not at the epididymis. If there was a bulge at the epididymis it would be from something else like a cyst. Dawn said that if they did reversal, it would just be the reversal, they would not attempt a second surgery to remove anything from the epididymis or drain any cysts unless it was in the way of the reversal.
What confuses me is that I have have two local urologists (both 20+ years experience) telling me I have granuloma at base of my left epididymis, both from feeling it and from ultrasound. But I have heard from two reversal surgeons now (also with many years experience) that they have never seen granuloma in the epididymis.
A few logical possibilities I can think of:
- Sperm are leaking from cut end of vas and dripping down to my left epi? [But if that were the case I’d expect inflammation and pain all along the vas.]
- My vas double backed and is now leaking sperm very close to my epi. [perhaps more plausible?]
- I am leaking sperm from where the epididymis connects with the vas [not sure if this is anatomically possible?]
- I have a bulge in my epidiymis itself, but it is a cyst not a granuloma. [my ultrasound doc told me it wasn’t just a bulging epididymis though, because there was no blood flow in the granuloma on the ultrasound].
- I really do have a granuloma in my epididymis. Maybe it is possible reversal docs don’t ever see it because it is not common for people to get reversal for it, they would just have the granuloma and/or epi removed?
You might be over thinking it too much. As you have experienced, there’s no easy answer unless you are in the operating theatre being open up. From my consultation with Dr Marks, he said that you can either have epidymal blowout or sperm granuloma on the cut end of vas. He mentioned that the type of reversal is decided upon during actual reversal. I remember having a couple of ultrasounds done prior to my reversal, and had different diagnosis.
I decided to take a leap of faith, and been nearly 7 months now for me, and am feeling like am slowly emerging on the other side. Still only 75% to normal, but better than pre -reversal
@SomeGreyBIoke, thanks for the reply and advice. I am glad you are continuing to improve and reversal has helped.
As I remember in your situation, you had an epidymal blowout and painful granuloma before your epididymectomy? If so, do you remember if the doctor who removed your epididymis found any evidence of a granuloma or cyst there?
My gut tells me that this marble-sized mass (whatever it is) on my left side is source of most of my problems. So if I am going ahead with reversal I’d want to know the doc would remove that mass as part of the reversal, or at least that odds would be high it would resolve on its own once sperm start flowing again. Rather than needing to a second surgery to remove it.
I am going to try and get a second ultrasound with another doc here locally to get his thoughts.
It’s a very slow and painful recovery, but am hoping things will eventually be better.
Yes that’s right, I had a epidydimal blowout caused by a bike ride. Tbh, I didn’t ask as back then I was very ignorant towards the whole issue. Eventually had orchiectomy, and year on, am beginning to feel good on this side.
I’m no expert, so don’t take it as a gospel, but once you have a reversal, and if needed you can have a VE, which will bypass this potential blockage, and in my opinion, it should shrink eventually, as you will not have this constant new flow to it. I think there is someone on the forum who just had reversal after 15yrs with Dr Marks, and had VE on one side. He might be able to give you better advice.
You’ve done your homework well, do whatever you feel is right.
I am a guy who had a reversal with Marks in January, fifteen years after vasectomy. Reversal was VV on left side, VE on right side. Right side was noted as blockage with scarring at epi tail. Possibly a blowout in the tubules causing the blockage or preventing flow.
Here is how I would think about your situation: If you have a blockage or cyst or “internal” granuloma (if that is indeed something possible), then you will not be favorable for VV, therefore he would do a VE higher up on the epi to bypass the blockage. Perhaps that by itself would relieve the pain?
If he does that I am sure he would note any abnormalities, like a cyst, even if he makes no corrections for it. Marks’ surgery report was pretty detailed, with observations about lack of granuloma, normal appearance of testicle on delivery, etc.
But I hear you on not wanting yet another surgery if someone odd was discovered during reversal. If you are considering reversal to potentially alleviate pain and other symptoms I do agree having the reversal done with an expert like Marks, Burrows and a few others mentioned on this site is your best chance of a favorable outcome and minimizing new damage.
@InForSomeChop, @SomeGreyBIoke, thanks for sharing your thoughts here, I really appreciate it and think we can learn from each others experiences. I do tend to overthink things my wife says. =) I realize there’s only so much research, thinking about it and praying about it I can do and then at some point I’d have to take a leap of faith. It will be coming up on 1 year this April since I first started having pain, and I feel that I’d need to try something different that what I have been doing.
@InForSomeChop, did they also include pictures of the testicle on your surgical report? I agree getting reversal done with an expert is best bet. For me personally, I would prefer a Urologist who does reversals full time so they have the experience, and only 1 a day so they are not rushed. So far I have only found 3 centers like that in the US.
Hi @worship01, I conclude that I have what you noted few posts above: “My open-ended vasectomy likely closed up and ultimately the backpressure caused blowout in tail of my left epi.” Mine is on the right side, swollen epi tail. I just can not figure out if right leg and back pain is related to that, or due to messed up muscles due to over 2 years of pelvic pain. What is your pain level now? I am at 2-3/10 most days, used to be 4-6/10. At some point last year I started planning on reversal but now I am just sitting on my situation, kind of getting used to it. Seems that my reversal would be VE on the right side.
Hi @Vincent my pain level is pretty much the same as yours. More annoying though is the feeling down my leg, like a sunburn or like I pulled the hamstring. Makes me want to limp. I also feel tightness and tingling in my perineal area and achey blue balls feeing if not on papaya seed. So I think combination of congestion and granuloma. I feel I will likely get a reversal, just not sure with who yet.
Hi @worship01 very similar, my dominant pain is also in hamstring. And I do have itching and burning pain in genital and perineal area. Hamstring pain comes together with right testicle and base of penis pain.
A couple surprising things after having an appointment today with Dr. Damani who is a urologist in Charlotte area who is fellowship-trained in microscopic vasectomy reversals. Notes in my own words:
- He examined both testicles and to my surprise, he did not find any mass or granuloma on either side.
- He said he could feel my vasectomy site really well.
- He said the right side epi (where I have no pain) feels fuller than the left side epi. Kind of surprising, but he said it all depends on how body reacts to the congestion.
- He said granulomas don’t form at epididymis, and you don’t see them on ultrasounds. They form at the vas site.
- I asked him why the urologists at the other practice said I had a granuloma at base of epi from blowout. He said the previous urologist I saw a month ago (who also does reversals) is not fellowship trained and he has to start over to re-educate people when they come from him.
- He advises vasectomy pain patients to wait at least a year to see if they improve, before considering surgical options.
- He said there were a couple surgical approaches for the pain: removing the epi one at a time, or reversal. He said that epi removal would have 75% chance of eliminating the pain. I said I was not interested in removing epi, even though it would be covered by insurance.
- His theory is that my symptoms are likely due to congestion and there was a 90% change of them being eliminated or getting a lot better after reversal. He has never had anyone get worse from reversal.
- He does 20-30 reversals a year. I asked him how many are for pain, and he said it varies but interestingly enough 2 out of the 6 reversals he currently has booked are for pain reasons.
- He does microscopic 2 layer reversals in hospital under general anesthesia.
- He would always do reversal on both sides, and is comfortable doing a bypass if needed. He said 80% chance I would not need a bypass. But he mentioned a guy only a couple years out from vasectomy that he had to do bypass on both sides, so it all depends.
- He would make incisions on both sides of scrotum and remove each testicle.
- He would look for best place to do the re-connection on the vas, and he would examine fluid on both ends of the vas. If blockage detected he would keep going further and further upstream in the epi until he finds sperm.
- He would advise stopping all supplements and even protein shakes, to see if helped improve things. He referenced some FDA study that alot of supplements/protein shakes had toxins, impurities, etc in them.
You reversed due to pain,side effects after 15 years?I was 10 years when I reversed.What were some of the symptoms?All good now?
No pictures of the testicle, just close-ups of the vas connecting to the epi.
Yeah, I wish I had done it sooner. Prior urologist and my regular doc said reversal would probably make things worse and did not reccomend it. So that combined with no insurance reimbursement kept me in my sorry state. It wasn’t until I found this site that I started thinking it might be a possibility for me. Then after my phone consult with Dr. Marks I was convinced I should go for it. I understood the risks, but saw some successful stories here and decided to do it.
I am all good now, no regrets other than delaying 15 years. Still waiting for semen counts to spike up, pretty low still but other guys tell me they had similar experience where it took many weeks for their numbers to rise.
My whole saga is here:
Reversal with Dr. Marks tomorrow morning, 15 years post vasectomy
I read your posts and they are incredibly similar to my pre-V/post-V/post-VR.I noticed a huge difference right of the table.I thought it was in my head.Its not.There is something about a vasectomy besides pain that is not good at all.Its a cut off feeling physically,etc.My posts are eerily similar to yours.Thanks.
Hi everyone, it has been a while since I posted an update. Pain/discomfort is still there but it is a lot less all-consuming of my life for reason I will share below. Therapy wise I have been using a gentle heating pad every day at work, and I think that has also helped me to be consistent with it, probably is relaxing muscles and inhibiting sperm production. I’ve stopped all other supplements and medications except 2 x serrapeptase/natokinase a day.
But the biggest thing has been my mental state and mood which was many times better these past couple months than the whole past year combined. I have been a lot more upbeat and positive which I believe has also helped my physically.
I won’t presume to know exactly what everyone else is dealing with, but one thing I have personally dealt with is feeling resentment towards my wife for her role in encouraging me to get a vasectomy after birth of our second child. After I got pain, it caused a rift in our relationship, and distance between us, and made things worse for me, feeling more isolated and bitter.
A few months ago I told her all of this, and that I forgave her. It caused her (and I) a lot of tears because she of course had no idea any of this PVPS pain would happen, since both of our dads had vasectomies done with no issues, and she didn’t feel she did anything wrong for me to have to forgive her. And in my head I knew I shouldn’t blame her since we both agreed at the time vasectomy was best thing to do, but I still did inwardly blame her.
Saying out loud I forgave her was more about me not holding anything over her personally, and I did feel a huge weight of my shoulders since then. She and I are more connected now and I know I will need her strength to get through this together.
I googled it and thought this was a good definition of forgiveness:
“Psychologists generally define forgiveness as a conscious, deliberate decision to release feelings of resentment or vengeance toward a person or group who has harmed you, regardless of whether they actually deserve your forgiveness . … Forgiveness does not mean forgetting, nor does it mean condoning or excusing offenses.”
Anyways, I don’t know what your specific mental struggles are, but I wanted to offer my experience in case it is helpful. I believe the mental and relational aspects of this are so important.