Post Vasectomy Pain Forum

Strongly considering microsurgical denervation for PVPS

I had my “stitchless” procedure done in jan 2020, just before the panedmic hit.

At first I thought all was normal and good, but after a few months of my left side still hurting, I realized I had PVPS. Tightness, soreness on one side. Almost like my vas is under constant tension. Other side is 100% perfect, fine, no problem. The difference is literally staggering. I was extremely active before my surgery, and since then, I have to ask other people to pick things up off the floor for me, I stopped exercising, no longer wear underwear, and if I put on pants that are anything smaller than hammer pants, i’m in agony all day.

The side that hurts is my “higher” side, it’s always felt tighter, but this is tension, like I’ve got a brick tied around it and i’m dragging it around. I wonder if during the original procedure the doctor stitched things up thru a nerve or something like that.

Between the pandemic and a dr who didn’t want to deal with the issue (he did an ultrasound, found a granuloma and said if we go back in there, it could just make it worse), I’ve only recently found a doctor who specializes in pvps (among many other things, for better or worse, he is also an ob/gyn). He did a first cord block (FYI, the injections hurt like hell) that maybe kinda helped a little for an hour or two. I went back and asked him to do another cord block and put “everything they had on the shelf in there” - this provided complete relief for 8 hours, which was amazing!

He’s got me booked for microsurgical denervation in a couple weeks.

“cutting the wire to the check engine light” doesn’t thrill me. It was explained to me that there’s a pain cycle aspect to this, and that if the cycle is broken, the issue can resolve itself. It’s not a theory I love, but the relief of pain from that 2nd cord block really was thrilling, and it’s hard to ignore that I could walk out of surgery and have it be like that from then on.

I’ve read some NIH research on the procedure online and it seems to have a good chance of working (75% complete recovery, closer to 90% at least partial recovery). Since there’s so little about it online other than NIH meta-study language, I was just wondering if anyone here has had it done, thoughts, comments, etc.

I have spent the last few hours reading around on this forum and I have come across several posts from people who are decidedly against this procedure. None of the posts i found mention if they had a successful cord block prior to the denervation, so I wanted to post and see what people thought. My current doctor is open to all avenues, and claims he does a few of these procedures a week, and that only in 1% of his cases does he need to do a reversal, so that gives me the impression he’s committed to helping his patients until they’re better, and that he is suggesting this option out of experience in success and not because it’s what he’d prefer to do.

Thoughts?

Bilateral denervation made my left side better right side worse. My left side was worse side. I got maybe 80 to 90% pain relief on left side. Right epi spermatic cord is totally fucked. It’s so sensitive it hurts bad. Just understand there is a small chance it could make things worse… My incisions still bother me alot to. I had the surgery December 8th 2020 I used to have bad burning adominal pain too. After denervation it went away which can’t be explained by doctors

It sounds like my symptoms are not as bad as yours (were). I’m going only for one side denervation, and my only pain is in the cord, tho it radiates upwards and downwards on my left side for about 6" or so.
It’s tough to decide - pick any procedure for anything at all, you can find 100x the number of people online saying it ruined their lives. Reviews skew towards failures often because people who are helped have little incentive to spread the word. What I’m reading here has definitely got me re-evaluating my enthusiasm for this upcoming surgery.

Out of interest - do you not want to consider reversal as first surgery to resolve it given that it seems to have the highest statistical rate for sorting PVPS issues? No judgement just genuinely curious, reversal is my absolute first go to to resolve my issues as the other options mean reversal is no longer an option, but with reversal first, you can go the other routes after

my wife and I would be OK with reversal to cure the pain issue. this is the first I am hearing of it being the best option, I’m going to ask my dr about it right away. We’ve read so many positive things about denervation, and the only things suggesting reversal for pain have come from these forums.

Question… since I’ve got one painful side and one side that is 100% perfect, it makes sense just to reverse the one painful side and not both, right?

Also, what are the odds that reversal causes more pain, given that my issue is pain from tightness - I worry that trying to join two shorter tubes (they were cut and cauterized) will result in more pulling/tension…

Hey mate, I can only speak for my personal opinion but for me, I lived for 29 years honestly with only ever having 2 minor sports injuries, never any health issues bar the odd cold that kids brought back from school. Since vasectomy I have constant issues like headaches, stomach pains, joint pains etc - in my own urologists words “some men’s bodies simply don’t like vasectomy and getting things flowing again is usually a high % chance of success”

So in my opinion and my own personal experience, the only pains directly related to the vasectomy I can confirm are dull ache at the end of the vas where it was cut, sensitive testicles, and my epididymis are about twice the size they were pre-vas and I feel like I am constantly fighting a virus(tiredness, muscle aches etc) and my orgasm is utter garbage now even when my libido is high.

From what I’m aware, if you opt for epididymectomy, micro denervation, orchiectomy - you can no longer attempt reversal, those options are now gone.(happy to be corrected about denervation, not 100% sure on this one)

If you get a reversal, those options are still available to you after.

Here is a study for reversal for PVPS; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5503916/#:~:text=A%20subsequent%20study%20performed%2C%20at,pain%20scores%20in%20this%20group.

" A subsequent study performed, at the same institution, showed similar results. Of the thirty-one men that elected for vasectomy reversal, 82% of patients reported improvement in pain . There was a 59% improvement in pain scores in this group."

I am 9 months post-vas and I am currently awaiting an “urgent time-sensitive referral” for an andrologist to reverse me, the sooner the better in my opinion, I guess my body just doesn’t like re-absorbing sperm and things not working the way they were intended - my main pains and symptoms are in my left testicle, and the problems I have got after the fact are up the left side of my body(endoscopy will reveal if I even have a stomach ulcer on thursday or if it is my ball nerves lol) - but I do get some pains in my right side and in my kidneys, actually I get severe kidney pains some times even when my testes aren’t sore - I will be getting a reversal on both sides 100% no hesitation, if my phone went at 3am to drive 4 hours to get it done I’d be enroute immediately. Here are the medical checks I have had in the last 4 months:

Bloods, urine, stools - No issues
Ultrasound of abdomen & renal tract - No issues
CT of kidneys - No issues
CT of brain - No issues
X-ray of Abdomen & Chest - No issues
Ultrasound of testes - No issues
Osteopath - No serious back problems
Endoscopy - Still waiting

I’ve got a call into my doc, waiting for a call back where I’ll ask his opinion on reversal versus denervation/etc. Thanks for the heads up

To my understanding, reversal is restorative whereas classical denervation (cord stripping) is destructive, leaves a lot of scarring and thus makes subsequent reversal more challenging. Dr P, when still with PUR clinic, had a sequence of treatments on the clinic’s homepage; I cannot find that anywhere anymore (also, Dr P is no longer with PUR clinic), but I do think they listed their version of denervation (targeted denervation, sometimes I have also seen it being called “neurolysis”) as a first line treatment BEFORE reversal. I believe the way they do it is less destructive (targeted to certain nerve fibers) and leaves reversal as an option possible down the road (https://purclinic.com/testicular-pain/). When consulting with Dr P via phone, based on my symptoms which are different than yours, he suggested reversal as first line surgery. You might want to talk to him, too. He is one of the go-to PVPS docs who offers all sorts of treatments including surgical options. I have also read cases on this forum where reversal was done first followed by denervation later. I cannot remember a case now where the reverse sequence was applied, but of course there might be also cases for that. Try to search this site, it contains a lot of individual stories that might give you a good impression. Hope this helps and good luck with your decision.

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I had my MSDS in June 2020 a year after a terrible Vas hematoma left me with a big mass/clot stuck to my left testicle and an inability to stand due to leg and groin pain.

They also removed the mass and scar tissue when they did the procedure. My left testicle used to feel like it was in a vice grip when I stood but that is much better after the Denervation procedure. Unfortunately I still have a lot of groin and leg pain so I can’t stand long but my Urologist said the MSDS targets the testicle main so he considered it successful despite the pain I am still in.

The surgery incision was pretty sensitive for awhile and I have the occasional sensitivity but overall I don’t have any lingering effects from surgery.

I’m evaluating a nerve stimulator trial as a next step.