I have seen a lot of discussion around spermatic cord blocks in the other threads so I thought I would post my experience and comments for newer guys coming to the forum. Bottom line is tread very carefully - I did a spermatic cord block a few weeks ago and ended up in the Emergency Room a few days later due to a huge increase in pain (lots of bruising, felt like the needle was still stuck in there). The block is proposed by urologists as both diagnostic and therapeutic but most of the time that is just not the case. From a diagnostic standpoint, I asked the urologist (top guy in the state of WI, has written articles about PVPS) where he plans to stick the needles (two of them in my case) and he said they just make an educated guess as to where to poke. So, they don’t really have a clue and that makes the diagnostic part pretty sketchy. In my case, I had 60% relief for 1.5 hours and then bigger pain after that than when I first came in. So, diagnostically speaking it was inconclusive and I went through all that pain for nothing. It took about 2 weeks for the swelling to go down. From a therapeutic standpoint, you only get very minor relief for a few hours at best. Not worth the trouble and don’t buy the urologist’s thinking around hitting the hot spot to calm it down.
If you do decide to play the spermatic cord game, make sure the urologist does it under anesthesia. In my case my nervous system and mind were already on high alert from the vasectomy trauma - as soon as that needle went in, my pelvic floor went crazy, my mind went crazy, and the scrotum pain increased substantially a short while later. You are re-traumatizing an area that is already pissed off.
If you want to do a nerve block for relief, avoid the scrotum area altogether and go up higher with a pain management guy. Even then it is a crapshoot but at least your not playing a dangerous game with an area already on high alert Hematomas, bruising, tissue damage is all possible with a spermatic cord block - low risk for that stuff but so was a vasectomy.