Post Vasectomy Pain Forum

Question concerning denervation/neurolysis with Dr. P vs. denervation with other doctors

Hi, I haven’t been on the site for quite a while. A short history: vasectomy in 2010, ongoing pain right away. Reversal with Dr. P in early 2013 with significant pain relief. Within a year or two of the reversal I had two short bouts of pain, each lasting a couple weeks, each spontaneously resolving. Now I am suffering another bout of pain, but it has lasted at least 8 weeks now. I have been holding off on contacting Dr. P again, hoping this episode would resolve too, but I’ve pretty much given up hope. I am predicting that when I do contact Dr. P he will tell me my options are to redo the reversal, or his targeted denervation/neurolysis. Browsing the forum I see a lot of negative posts on denervation. My question is do these negative comments also refer to Dr. P’s more specialized denervation, or just to the traditional type that other doctors are performing? Thanks.

Jeff J.

I think many of us on here have the same concerns and q’s as you.
My 2 cents, if you are considering denervation only two people to reach out in North America.
They are Dr. P Florida and Dr. Jarvi in ON Canada. I would consult with both before you do anything !

When’s the last time you had an SA?

What were your post reversal SA numbers?

I’d be checking that stuff out before anything else.

I haven’t had an SA since shortly after the reversal. The numbers were good then. I assume that will be something Dr. P will order when I schedule a phone consultation.

Right now I’m gathering information so that I’ll be able to ask informed questions when I do talk to him. I don’t want to say that there is concern on the forum about denervation when in reality the guys here talking negatively about denervation are talking about traditional denervation, not Dr. P’s technique.

Another thing I’ve noticed about the forum is the discussion of orchiectomy. Back when I was more active on the old forum the mention of orchiectomy was pretty much taboo. Several comments on here that I have read are pro orchiectomy while being very negative about denervation, so I’m just trying to sort things out.

There for a few years I thought I was pretty much over this ordeal, but I guess not.

Has it been suggested to anyone about the difference between microsurgical denervation vs radio frequency nerve ablation?? & is it Just me or should we be dealing with neurologists or neurosurgeons & not urologists to investigate these options?

Hi Jeff, I had denervation with Dr P and my pain went from intermittent to chronic. I have made a few posts that if you have pain in the vas deferenes you may want to think twice about this surgery. The problem with the procedure is that nerves grow back. I felt better for about 6 months out and then have been in daily pain since (about 4 years ago).

My suggestion is not to have it, but if you are going to I would only have Dr P do it. I would want to know what the long term success rates are for this procedure - on the website it states 85% but if this is based on patients right after the surgery that is not a good indication as the nerves can grow back and can be very pissed! I have chatted with others who had bad outcomes even with Dr P. You should do a google search on what happens to nerves after denervation - there are some definite changes probably none which are good. I think that people with one-sided testicle pain might do well but if you pain is in the vas you are likely going to have nerves grow back in that area which are not going to be happy.

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Can you redo the denervation after the nerves grow back? What has Dr. P advised?

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Hi all,

Who is Dr. P again? I’m in Ohio and probably going to have MDSC with Dr. Shoskes at Cleveland Clinic, but I’d like to consult with him on any current research.

Thanks!

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I’m a Clevelander and have seen Dr. Shoskes. Dr. P. is Dr. Parekatill in Orlando. He actually did his fertility fellowship at the Cleveland Clinic under Dr. Thomas who did my reversal in 2006.

I came very close to doing MDSC back in 2018 but the pains went away after a series of injections. I think you’re in good hands with either one. Proximity can be a deciding factor, for sure. That favored Dr. Shoskes for me. Bedside manner can be a deciding factor, too, and for me, that favored Dr. P. Also, Dr. P. does offer other treatments including therapeutic (not just diagnostic) steroidal and even botox injections. Botox delivered by Dr. P. did the trick for me and I ended up foregoing surgery.

Again, I think you’re in good hands with either one for MDSC. Both very experienced, probably the two most experienced in the country outside Dr. Levine in Chicago.

Best wishes.

Could you fill us in a little on your experiences between your reversal in Dec 2018 and today? Have things gotten worse that you are considering MDSC? Stayed the same?

So I am working with Dr. Shah here in Cincy and he is great. I just spoke to him about possible Botox injections and he was very curious to know more.

Do you know what exactly is in Dr. P Super Cord block? Was that the botox injection?

Dr. Shah would love to know the methods and doses. He says he would be happy to mimic the process, but would want the first try of shots to be from someone with a lot of experience doing them.

I am very interested in trying any and all injections possible before scheduling an MDSC. My pain levels are tolerable, but only if I don’t run, ride a bike, or sit for long periods of time.

Did you have any luck with steroid injections?

I’ve tried all of the oral prescriptions on here and nothing helped (gaba, amatryptaline, etc). I even tried Floxmax. FYI NEVER take that stuff. Sex and orgasms reduced by like 90%, it was aweful.

Hi Ethan,

It’s hard to tell. I was really bad before my reversal, but was sitting in an office chair for 9 hours a day. Since the reversal, I took a job working from home and I now use a gravity reclining chair in my office. Seems to help with soreness from sitting.

In terms of pain levels, I think I’ve seen some improvement, but not much. I cannot jog or run more than a block before feeling sick with pain. I can feel every jolt as my balls bounce, not great.

I have found that wearing these helps a lot (I have like 12 pairs). Sometimes I’ll add a small microfiber (cheap at harbor freight) towel on the inside to make a nice soft pouch. Most boxer briefs are too restrictive, and boxers are not supportive enough.

Like others have said, reversal seems like a crap shoot, but it is nice peace of mind to have things put back as normal as they can, and remove scar tissue is the process. Just be sure to go with someone specialized and has a fellowship with microsurgery.

I did get analysis done after the reversal and was back to normal sperm counts, but who knows now. I’d rather just keep believing both tubes are open and functioning normally.

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Dr. P’s “mega block” that us forum members have dubbed it can be with or without botox. My first one with him in April 2017 was just anesthetic and steroid. The second and third, in June and October 2018, included botox. I actually had to pay out of pocket for the botox portion of those, about $1,000 each! But, they worked really well.

Even small amounts of pain can be mind-numbing and depressing if chronic over long periods of time, especially in the region we’re talking about. I’m a fan of trying injections before surgery, even if for the diagnostic benefit. If Dr. Shah isn’t comfortable delivering cord blocks or specific nerve blocks (higher up), he could probably refer you to Pain Management or a radiologist who does. I’m betting there are ones who could treat you in the Cincy area.

Same here. I got some mild benefit from amitryptline, but not gaba. A bit more from Lyrica, but my insurance wouldn’t cover, and it was too expensive.