Post Vasectomy Pain Forum

Spermatic Cord Denervation Articles

Considering this procedure and have collected some articles that I wish to share with the community.cln64_5p393.pdf (1.1 MB)
ContentServer.asp-43.pdf (841.5 KB)
tau-06-S1-S30.pdf (780.7 KB)
wjmh-37-78.pdf (323.7 KB)

1 Like

Thanks for sharing. Did you manage to read them and x-check whether same sources of information about patient statistics were used (cross-references)? Did you also compare these outcomes against other, older published papers, also available on this site?
From what it looks like, MSCD is promising, but if you read blogs on this site, there is tendency to question the high success rates based on responses here (especially long term successes, considering nerves re-connecting causing more pain).
I’d love to hear your opinion!

1 Like

@Juno. I’ve read them and while each one quotes the same older studies, they add the results at their own centers and remain in the 75-80% range of success. My own surgeon perhaps not wanting to get my hopes up too high is giving me a 50% chance at total relief and 75% chance of significant relief. He’s done several hundred of the SCDs. I believe that this is a reasonable procedure, but not without risk. You are irreversibly damaging a nerve.

A few thoughts:

  1. No one likes to publish stories about their failures - but we may be seeing only the results of more skilled surgeons.
  2. We are seeing only the results of academic urologists. I am assuming that there are skilled docs out there who are simply too busy to publish.
  3. If you are consulting someone who hasn’t published their results, it will come down to how much you trust this person. You don’t know what their long term experience is. (Wish someone had clued me into that before I had my vas!)
  4. You want someone who has significant experience, but be wary of someone who is cranking out a super high volume of procedures. Quantity does not necessarily equal quality in all cases. I suspect that with more experience in general, the overall quality of the procedure may be improving.
  5. I am uncertain how much robotic approach adds to this procedure. According to surgeon friends, at this point, it is really whatever technique you are more comfortable with.
  6. Patient selection seems to be a huge factor. A good response to temporary block should be a must.

OK Roy, so you’re so damn smart…what are you going to do?

Dunno.

Had good response to nerve blocks x 2 with complete relief the first go round, and 80% the second. I am 13 months out from my vasectomy. Still with significant pain BUT, 5 months out from reversal am slowly getting better. I can have sex now. Not much pain during- but sore for a few days afterwards with burning pain in the left testicle and inguinal region. Still it happens. What are you going to do? I can exercise at low intensity, but anything high intensity shuts me down. There are spans of the day that I don’t think about pain, which is new. I weaned off systemic medications that were affecting my mind negatively.

My intention is to give pelvic PT and massage therapy my all and reassess in two months. If I am plateaued I will probably pursue this I’ll keep you informed of how the adventure progresses.

3 Likes

@Roy, thanks for sharing your thoughts. I assume your surgeon is a urologist and the surgery would be done “down” somewhere near the vas location?
I read so many (conflicting) information on (M)SCDs, neurectomy, denervation, cord stripping (which in layman’s terms, for me, mean all the same, but I understand there are differences in the approaches; I remember there is on thread detailing the PUR approach vs. the “classical” approach), that I got really confused. However, there were a few consistent advices WHY not to cut the nerve higher up, not by a urologist, but a peripheral nerve surgeon, because there is apparently less risk of nerves reconnecting. That’s why there is not a lot of long-term success with MSCD. One of the papers above gives positive responders after 3, 6, 12, 24 months - interesting to see, the longer, the lower the score.
What’s your view on that?

You are correct in that neurectomy, denervation are all the same- cutting the nerve.
I am not so sure about stripping- but with the vas deferens, nerves, artery, and lymphatics all running in the spermatic cord- these structures are separated and identified during the surgery before anything is cut.

My understanding of the surgery is that it would be done up in the inguinal ring, way north of the vasectomy location. The nerve branches off there before it goes through the spermatic cord. So, yes, less chance of reconnecting, but also not affecting truncal musculature or the penis. Not sure why you would go higher than the inguinal ring- unless the SCD did not produce results.

These pictures from Grant’s Atlas may help shed some light on that.

IMG_4511 IMG_4510 IMG_4511

Regarding the long term follow up. I’ll need to research a bit more before I reply.

And I forgot, my doc is a urologist.

Regards,

Roy

Looking at https://www.drfenig.com/specialites/microsurgery/microsurgical-denervation-of-the-spermatic-cord/, it seems “cord stripping” and MSCD are used synonymously.
In my previous reply I actually meant:
“However, there were a few consistent advices WHY to cut the nerve higher up, not by a urologist, but a peripheral nerve surgeon, because there is apparently less risk of nerves reconnecting.”

There is another paper on this:

I think that too high up and you’d risk injury to the femoral component of the genitofemoral nerve with resulting limb weakness. (my opinion only).