Post Vasectomy Pain Forum

When to have denervation/neurolysis

From my experience and others that I have read on here, I would only have denervation if:

1/ You only have testicular pain after vasectomy
2/ You have testicular pain due to some other reason

I would not recommend denervation if you have pain in the vas deferens and the pain seems to spread everywhere - back, legs, hips etc after vasectomy. This pain could be nerve pain and it seems like it would make sense to block or cut these nerves, but in my situation it only made the nerve pain worse. I’m not sure if this is due to the inflammation and/or scarring from the denervation, or the nerves growing back and being more sensitive, but my nerve pain actually got worse 6 months post surgery and every day since.

I was in a position where I would do anything to get rid of my pain. Looking back I should have opted for pain modification and making changes in my life instead. Anyway just wanted to let you know that nothing is a guarantee in life and in some occurrences, can make things worse.

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I am sorry to hear about your experience. It hurts to read stories like yours, I feel with you.
Where did you get the denervation, i.e. at the cord (microsurgical cord denervation) or were nerves cut higher up in the inguinal canal?

I had cord denervation

I tend to believe you’re right. I think SCD MAY be helpful for localized scrotal pain but if the damage has gone further up the cord to the groin, legs, etc., I think SCD is like trying to put toothpaste back in the tube.

I’ve read your story and been wondering how you’ve been holding up and then I came across this. Sorry to hear you’re still in pain. I was hoping with time things would have settled for you. If it helps, you are literally saving lives. Dr. Jarvi recommended scd for me and because of brave people like you and others on this board I have chosen not too and seen some improvements myself with time.

Yes, I forgot to thank you for posting your story. It’s a shame that some of these therapies make matters worse.

Can you tell us about the prep you did prior to the SCD? The uros all seem to prescribe it if and only if you have a positive response to a cord block. The evidence on this board doesn’t seem to make that a hard and fast rule.

Also, it sounds like you had pain outside the scrotum based on your recommendation to only have SCD if your pain is localized, correct?

Last question, would you mind stating where you had the SCD surgery?

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Just doing some of my own research on here, as I was planning on maybe getting a reversal through Darby Cassidy here in Canada. Here is an email he sent me in regards to having a reversal or having denervation. Ive read up on him and sounds like he’s written some books and is a bit of a pioneer of sorts. Right now my symptoms lean more towards denervation:

"The short answer is maybe. The long answer really depends on what kind of pain you are having.

Post vasectomy pain syndromes are typically related to one of two separate causes. The first is related to the obstruction itself, and is caused by epididymal hypertension. This pain is typically worsened with sexual arousal and associated with significant ejaculatory and post-ejaculatory pain. This type of pain can be managed with a unilateral vasectomy reversal with an expected success rate in the range of 70–75%.

The other source of post vasectomy syndrome is neurogenic in origin. This pain tends to be more constant in nature and often associated with radiation of pain. This type of pain is best managed with targeted microsurgical spermatic cord denervation which is associated with an approximately 85% success rate.

My recommendation would be to have your urologist perform a left spermatic cord block which helps determine whether or not the pain is neurogenic in origin. This helps guide treatment.

Thanks,

Darby James Cassidy, MD, FRCSC"

Food for thought on everybody’s research.

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That is definitely the very short answer regarding signs and symptoms and which may be a better option - reversal or denervation. Epididymal hypertension is the scientific term for the slang term blue balls. Sperm granuloma among other things is included in congestive symptoms.

There are pros and cons to both procedures and nobody should be unaware that these procedures tend to not be created equally. All reversals certainly are not created equally and the same can be said about denervation. I have written a very long thread on the reversal aspects.

Years ago, I can remember hearing from dr/surgon so and so that having a robotic targeted denervation first was a smart idea as the vas/s and such are left in tact and it was a less invasive procedure. From there, he/she suggested that you can always have a reversal after the fact like that was some sort of smart ideology.

I certainly didn’t agree with dr so and so’s philosophy - ever, and neither did a lot of other people. All at the same time, it really doesn’t matter what I or others agree with or not. People are going to make choices for themselves on this site - not vice versa. What’s best for them, what’s best for their potential family, etc - it’s their life and nobody has to live with their decisions but themselves. Different strokes for different folks. As long as men are making truly informed decisions for themselves beforehand (details, pros cons etc’s), that is the most important aspect to me.


It would probably help to understand the rest of the OP’s timeline of events, his other comments, etc. All of that information can be found with ease on this site. As I recall, he had a reversal first and more less jumped into having targeted denervation without considering all of his options. Considering his pain levels beforehand, his options included waiting things out for an extended period of time. The reality of the pros and cons of having targeted denervation done to himself beforehand (is it worth the risk) - or any version of denervation for that matter. I feel pretty confident that his doctor/surgeon suggested it was a good idea to proceed with further surgical intervention as well. The idea that he/she didn’t recommend it to this gentleman seems rediculas and unlikely to me.

As I recall, the reversal this gentleman had beforehand helped him, and post denervation he wished he’d just left things alone and banked on getting better all the way with just time alone or something along those lines.

Keep in mind that the outcome of the OP of this thread hasn’t been updated in over 2 years. It’s hard to say how this gentleman is doing today.

FWIW, anyone can click on his username (or anyone’s username for that matter) and click it again - then open the expandable tab and click activity to read all of their posts on this site in chronological order.

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I forgot to mention that the success rate statistic with targeted denervation specifically seems to vary surgeon to surgeon.

There are threads on this site that include numerous studies from various surgeons on various versions of denervation including the targeted version. Those threads shed better light on that perticular aspect.

There are numerous quotes on this site like the one above. The success rate numbers certainly vary which isn’t surprising to me. We have other second hand quotes on this site that supposedly came straight from the horses mouth/s. One such second hand quote was said to have came from a surgeon that gets mentioned on this site frequently.

Paraphrasing, that quote went something like - “50% of men that have targeted denervation with that particular surgeon hit the jackpot”.

Bottom line - high success rates like ~85-90+% sound really great but the reality is ~85-90+% of men that have the procedure do not hit the jackpot which I think anyone would all assume means pain free.

There’s a lot more that I could get into here, but won’t. If anyone is truly interested in learning more about these kinds of topics on this site, use the search bar to find the threads and posts I previously refered to.

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