Post Vasectomy Pain Forum

Reversal Decision Time

I shared my initial PVPS experience and results with non-invasive therapies in this thread.
My Experience, with list of non-invasive treatments

I was very hopeful I was putting all this behind me this last summer. I was nearly pain free. Then I had some flare ups and things have trended worse over the Fall and Winter. I had to start taking gabapentin again and the side effects are like a lobotomy. I can’t live like this anymore and I’ve decided a reversal is my best first surgical option. Experimenting with papaya seed powder really tipped the scales. I could feel my testicles and epididymis swell up and get painful as I stopped taking it. I think all the neuropathic issues were triggered by constant low grade pain and irritation in my scrotum. I wasted too much time thinking it was just a nerve issue and that denervation was my only option. If anyone wants to talk me back form the cliff I’d like to hear why.

I’ve had phone consults with Dr. Parekattil at the PUR Clinic and Dr. Burrows at the ICVR. The main differences I could discern are the following:

  • PUR clinic is more pain oriented where ICVR is more strictly for reversals. If a reversal doesn’t help the PUR clinic will be more of a partner in further treatments. That’s not to say that ICVR ignores or is unaware of PVPS, its just not their main focus. On this point I lean towards PUR.

  • Dr P. cautioned me that most reversals close up over time while Dr B. did not seem to think this was true. I can’t tell if this born out of studies of reversal or their own patient’s results. The question it begs in my mind is does one have a better procedure and hence outcome than the other? I lean towards ICVR here, since their claim to fame is getting those pipes open successfully again.

  • At PUR for pain patients they only perform vas-vas reversal where at ICVR they check for sperm in the fluid and will perform a vas-epi if necessary. I’m torn here. A vas-epi sounds more complicated and risky for additional pain. But if I need to relieve the build up and a vas-epi is the only way around a blockage then so be it. Both said that at under 2 years out a blockage is highly unlikely so maybe its a moot point.

  • ICVR is about 30% more expensive. But at this point I’d sell my soul. So I’m trying to not let that weigh on my decision.

  • Last the PUR clinic uses robotic microsurgey for part of the procedure and ICVR does not. On this point I’m indifferent and have no reason to say one way is better.

I’d love to know if others considered these clinics, which they went with, and why?

I’m in Milwaukee WI and haven’t found anyone in driving distance specializing in reversal and PVPS. Does anyone know of any such doctors or clinics in this area? I tried contacting Dr. Douglas Schow of the Minnesota Men’s Health Center but it doesn’t seem to be open? The website phone number goes to something else. I thought there must someone in Chicago but I couldn’t dig up any leads. I had my original vasectomy at Froedtert hospital, so that’s clearly out. I’m not giving them any more money after what they put me through.

Here’s a urologic surgeon in Chicago who does reversals and works with men’s health. I almost chose him, but went to Dallas instead.

https://www.feinberg.northwestern.edu/faculty-profiles/az/profile.html?xid=10530

Go with your gut feeling, we should have listened to it before vasectomy, wouldn’t be in this predicament. Is 30% worth it?

I agree 100% about going with your gut on the original vasectomy. I’m thinking of getting a tattoo that just says NO in big bold letters. It will remind not to agree to BS that other people want me to do.

But I am very torn between these 2 clinics. I am trying not to consider the cost difference. Right now my lizard brain is saying if it costs more it must be better. But that seems like flawed reasoning too.

If you think about this logically, the purpose of reversal is to attach 2 tubes back again. IMHO, whichever clinic you chose, you’ll have the best care there possibly is in the world. Just go with the gut feel and don’t over analyse it ( I know easier said than done, I’m an engineer too ).

Hi @WtfMyNuts

My reversal doctor was proficient in both vas to vas and vas to epi. He said he wont know if he has to do a vas to epi reversal untill he gets in there. I would make sure both places are prepared and have the experience to do either one. Maybe something to keep in mind. Ah I see you point about the vas to epi now. What does the other clinic do if they can’t do the vas to vas reversal? Just close you up?

Also considering reversal for pain and deciding between PUR ICVR with a similar analysis. I spoke with DrP today and he said that they’re working on a standalone clinic that will further reduce prices next year (maybe $4500). But like you, i’m quite ready to pay for the best possible care. It does seem that both organizations are doing best-in-class work.

Like ICVR, Dr P only does one reversal a day. However, he also performs other procedures and didn’t say that the reversal was the only procedure on a given day (not sure there).

Dr P told me that his costs are actually quite high (>$20K) but that he’s able to offer competitive prices thanks to research grants and endowments.

ICVR refers pain patients that don’t see improvement to the PUR clinic.

On paper, starting with PUR seems the best to me. But I recall reading that @RingoStar had a reversal @ PUR and a redo with ICVR and in his case ICVR had better results. It’s a sample of one, but gave me pause. @RingoStar not sure if you have more to add on this subject.

I don’t have much of anything new to add to this subject @alden.

My experiences we’re back in 2010 - 2011 and some things have changed since then. I have posted my input on the reversal subject countless times on this site. Given my singular personal experience, I am a believer in getting it right the first time. Don’t rush into anything. Don’t let desperation lead to bad decision making. If you’re gut is trying to tell you something, you should consider listening to your instincts. Ask all the right questions beforehand, and be sure that you completely understand everything involved with what you are considering getting yourself involved in. From the procedure itself, to the follow-up protocols, to how many procedures a specific surgeon is doing in a day, are they cramming rushing etc, to their specific methodology used during you’re reversal procedure, to their experience level with a specific procedure or methodology, big picture statistics, the recovery process and possible recovery timelines, and so on.

In all honesty @alden, I prefer to let men make their own educated decisions. I prefer to not influence them to go anywhere specific, nor to do anything. People do ask me all kinds of questions and I’m always willing to give men my input, my opinion, and so on, but from there, I prefer to let men make their own decisions and I have good reasoning for why. It boils down to not wanting to be a part of anyone’s blame game if things go to hell on them. Anyone that reads many of my posts knows that is possible, but they seemingly forget about that after all is said and done and everything has gone to sh-t. Sure, that doesn’t happen often, but it certainly happens. Many men want to blame someone, and I don’t want them to blame me.

I do see some things in your post that I could pick apart for further examination, but my guess is that after reading my response, you see them to.

I have heard countless post reversal stories from men that used either of the surgeons you mentioned previously and beyond. I read every single post that comes through this place and I sense or know when someone is getting some smoke and mirrors blown up their a$$. Generally speaking, I say nothing. I have said my piece countless times. Nobody can tell me, hey, why didn’t you ever say anything? My response would be, I have stepped up and said something countless times. Seems many want to shoot the messenger :roll_eyes:

Hope that helps.

Hi @alden,

Would you be willing to share some other details about your story? When was the vasectomy? What symptoms/experiences have you had? etc.

Good luck with everything!

@RingoStar thanks for the note. Your contributions to the forum are invaluable and I completely sympathize with your preference to let folks make their own decisions.

@Ethan_Scruples I’ve been meaning for some time to add my own story but found myself subconsciously waiting for some clarity on it first… that’s been slow in coming.

I got the Vas ~22 months ago in Palo Alto, CA. My wife and I had kids at a young age (I’m 28 now) so with many years of fertility ahead it seemed smart and she was very anxious about accidental pregnancies. I didn’t want to do it, but was drinking the “right thing to do” line of thinking pretty hard at the time so I went through with it. Since I’d been told it was a “simple/safe” procedure, I took the first surgeon who was available at the Stanford hospital.

The recovery was rough, but not more so than expected. I was up walking around after a few days and feeling 90% after a week. I had a much stronger emotional response though than the pain alone would account for – lots of depression and regret.

I realized something was wrong when the pain didn’t go away. Over the past year and a half it’s been a frustrating up-and-down experience. Nothing is constant – pain levels and symptoms vary a lot: 0 on some days, maybe 4/10 others. It also seems to get worse when I think about it more and/or have other sources of stress so definitely a mind/body piece here too.

At some point I spoke to another urologist in the Bay Area who said there was really nothing to be done and doubted if the pain was really caused by the vasectomy, but did suggest I stand more when at work (I’m a software engineer). That turned out to help quite a bit.

Over the last year new issues appeared related to posture and the pelvic system. I’ve dealt with a feeling of abdominal bloat even though I’m quite tall/thin. Also IG like symptoms. I got some relief from Alexander Technique and Esther Gokhale’s great work on healthy posture, but I’m still dealing with this. As I write this, I have level 2 pain in the right testical and hernia-like bloating and discomfort on my left side. I’ve also had lower libido (not surprising with pain following ejaculation) and perhaps generally lower energy.

I’ve had a T test (normal) and an ultrasound Dr P ordered that confirms a varicocele on my left side. I’ve not had any interventions so far aside from experimenting with a few supplements and the posture work I mentioned above.

I haven’t felt well since the vasectomy. But i’m at a point right now where I can live life. I can play with the kids and go for long walks, etc. I work from home so have much needed flexibility. Sex is reduced, but still good. I’m thankful for this, but it makes the reversal choice difficult.

If I had any confidence it’d help I’d drop the money on a reversal and deal with the recovery process, but going back under the knife is scary stuff. And with a paucity of solid evidence, lots of research hours don’t seem effective. Probably the biggest rational pushing me towards reversal is all of the long-term structural changes that a vasectomy causes and hoping that my 20 year prognosis gets better if I attempt to restore a more normal structure.

That said, there are plenty of guys who have had a reversal and would still feel lucky to have my level of symptoms, so nothing is obvious.

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Thanks, that’s a good summary.

Everything I have read over the last couple of years points to reversal giving significant improvement about 80% of the time. Of the rest of the guys, most just stay about the same. A couple see their neuralgia increase, and there are rare instances of complications like testicular atrophy.

Unfortunately I doubt you will get any more certainty than that. Just depends on how you want to place your bets, how much pain you have, what is the risk to your wife, what are your other contraceptive options, can you afford it, etc.

One thing to keep in mind if you go that route. Reversal makes everything feel worse for a few weeks or months. That’s normal so don’t freak out. Just tell yourself to withhold judgement until the healing is finished.

No problem @alden.

Another reason I don’t have much to say beyond all that is, I know of countless men that jumped ship ASAP post vasectomy that have zero regrets about it. In fact, those men say things like the vasectomy was the worst decision in their life, and a reversal was their best decision since, and I completely understand that. I personally think vasectomies are oversold, and in the vast majority of cases realistic outcomes, recovery timelines, etc, are not as described. I don’t shame those men for jumping ship as soon they did. They did what they thought was best for them, and everything worked out. It’s good to know those men got the majority of their lives back.

I will also point out that ~many men that post in forums like this one do not have what I would refer to as ~chronic pvp, pvps, etc. Over the last ~decade, I have spoke to, PM’d with, corresponded with, etc, countless men that hated the vasectomy, side effects, etc, more than anything else. Again, I completely understand that.

For what it’s worth, I don’t recall the last guy I have corresponded with that I would refer to as a low pain, side effects, etc, guy that had a compitent reversal that regretted it. But, I’m absolutely certain that it’s happened to someone/s.

Furthermore, we have a few pain guys on this site that had no pain prior to a VR for purely fertility reasons, that ended up with chronic pain as their outcome. Let’s not assume anything about all of those cases because there is a lot we don’t know as fact. Whatever the case, sh-t is happening to someone/s post reversal. Bad surgeons, a bad day for an experienced surgeon, bad luck, cramming, rushing, perhaps those men drew the shortest straw, and the list goes on. Again, let’s not assume way to much.

Best of luck with whatever you decide to do.

@Ethan_Scruples

Everything I have read over the last couple of years points to reversal giving significant improvement about 80% of the time.

Yep, also roughly matches numbers from PUR and ICVR.

One thing to keep in mind if you go that route. Reversal makes everything feel worse for a few weeks or months. That’s normal so don’t freak out. Just tell yourself to withhold judgement until the healing is finished.

Thanks for this. I slipped into pretty unhelpful “how could I do something so stupid” patterns of thought after the vas and my wife’s advice to me (she supports the reversal if I go that way) is to steer clear of that place should the reversal recovery prove difficult.

For what it’s worth, I don’t recall the last guy I have corresponded with that I would refer to as a low pain, side effects, etc, guy that had a compitent reversal that regretted it. But, I’m absolutely certain that it’s happened to someone/s.

@RingoStar this is interesting. One question I’ve had is if the 80% that see improvement are going from 8 to 2 vs 2 to 0. If the reversal resolves a severe class of pain but introduces a new, more mild pain, then mild cases may be seeing far worse outcomes than the stats imply.

To illustrate, if everyone came out of reversal with level 2 pain, then anyone going in with level 1 pain would get worse and anyone with > 2 would improve. So the distribution of pain severity matters when reading the statistics.

If you’ve conversed with a number (any idea how many?) low grade pain reversal cases and they saw improvement, that’s heartening.


@WtfMyNuts sorry to hijack this thread though. I’m sorry you’re also doing this and wishing you the best with the reversal. Please let us know who you decide to go with and keep us updated on your progress.

Someone here did a survey of all the reversals on the site, along with whether they got better, stayed the same, or got worse. I can’t find it right at the moment. Maybe someone who can remember who the author was can pull it up.

For other abridged case studies, you can check out the reversal-stories page on my wiki here:

https://www.reddit.com/r/postvasectomypain/wiki/reversal-stories

There are 91 stories on that page so far. But be advised that page is biased toward the “didn’t work” because those are the guys who tend to post about their ongoing unresolved issues.

I like to see the gears turning @alden. You seem to be thinking some of this stuff out. I won’t comment on your thoughts, but I like where you were going with it.

It’s hard to accurately say just how many men I have corresponded with over nearly a ~decade. I didn’t keep a physical log. I kept a mental log and it’s pretty accurate. I’d guess that I have privately corresponded with as many as ~60 - 80 men, and approximately one third of them were in the low pain side effects category.

Keep in mind that everyone is different. There are plenty of men that are happy with their vasectomies and many of them have some sort of pain and side effects. Ultimately, there is no one path for every man. Some this, some that, and some the other, and it will always be like that.

@alden, after 24 hours of thought, I edited this post.

It’s in the thread below.

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@RingoStar @Ethan_Scruples thanks for the info / links! Ultimately I’ll just need to make a choice realizing that certainty isn’t possible. If I bite the bullet and get the reversal then I’ll be sure to share the reversal journey/updates on the forum.

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@WtfMyNuts - Alex did you go through with reversal and if so how are you today?

I did. The pain is different now. But overall no better.

Regrets with the reversal or still glad you went thru with it? Are you planning any further procedures given the pain is persisting or planning to wait and see?