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Vasectomy pain presenting in leg

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    I had a vasectomy in May of 2001. My urologist used a no scalpel method on both sides, bringing out the vas and then cutting a 1.5 cm section-cauterizing the lumen and then over-sewing both the proximal and distal ends in addition to using small hemoclips to finish the job. When the right side was done I experienced a sudden jolt of pain at about the moment the vas was “grabbed”. My recovery was slow and I experienced testicular pain on the right side for weeks after the procedure.

    About the same time a pain also developed above my right knee in the soft tissue on the inside of my leg about 3 inches above my knee cap. The pain in my leg and the testicular discomfort were initially thought to be unrelated, but over time, a linkage has developed. Additionally, lower back pain on my right side, just behind and below my right “love handle” developed. Over the past 6 years I have sought to get to the bottom of what has become chronic pain in my leg and testicle. My right testicle is constantly tender and if touched in a bad spot, or twisted by crossing my legs or shifting while sleeping I will get a major jolt of dull pain in my groin. In addition, I experience lower back pain and most chronically a severe hot type pain above the right knee.

    My GP has been helpful trying to help me navigate my way though:

    • testicular ultrasound (unremarkable) MRI and X Ray lower back looking for disc compression that might be causing the leg pain (negative)
    • nerve conduction study on my legs (both) and back areas that showed a decreased amplitude of the right femoral nerve pathway
    • MRI of my pelvis for nerve compression or similar (unremarkable)

    Follow up with the urologist who performed the vasectomy, who acknowledged my “pain syndrome” resulted in him referring me to a physiatrist whose conclusion is that my psoas muscle is in constant spasm on the right side and it is essentially pulling on my genital/femoral nerve causing the leg pain to present at the terminus of the nerve path-which is just above my right knee. The physiatrist speculates that my body is tensing around my sore/damaged testicle causing the spasm and thereby keeping the nerve in my leg in an irritated state. It hurts almost all the time and is getting worse. I have a desk job and sitting is the worst for this. Long drives are agony with my leg getting very painfully “hot” with nerve pain. Any twist or jolt of accidental contact with my right testicle can set off my leg pain and leave me with a dull sort of nausea in my right testicular area. The pain in my right testicle is localized in the top.

    I theorize that the hemoclips may be irritating the sore right side-something is certainly wrong there and it is getting more sore as time goes on. I would appreciate any insight or opinion on my case and or help finding a urologist who specializes in a condition such as mine. I am willing to go to any lengths to resolve this. Thank you very much.

    Dr. Edward Karpman

    The association of knee and/or back pain after a vasectomy is certainly a unique symptom after this procedure. The genito-femoral nerve has an origin from the L1-2 lumbar root and is essentially two nerves. The femoral branch is sensory and receives stimuli from the medial (inner) thigh region close to the groin. The genital branch is a motor nerve and innervates the scrotum and cremaster muscle on the same side. A simple way to evaluate the function of this nerve is to scratch the inner thigh and the scrotum and testicle on the same side should contract. If this nerve is damaged or irritated one might lose this reflex. A more sophisticated study would be to do a nerve conduction test on this nerve to see if there is any abnormality. A spasm in the psoas muscle can cause this nerve to be irritated. If there is chronic testicular discomfort in the testicle or epididymis after a vasectomy then splinting on that side could, theoretically, cause irritation of the psoas muscle and subsequent nerve irritation. However, muscle spasms are a very common problem in men and women and can also be unrelated to a vasectomy.

    A nerve conduction study would be the best way to identify if this is the culprit. A nerve block at the spermatic cord would be another good diagnostic study to evaluate if the pain is originating from the testicle/epididymis. A vasectomy reversal or epididymectomy would then be the preferred method of treatment.

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