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Will neurectomy resolve post vasectomy pain?

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    I am a 44-year-old male who was in good health until I had a vasectomy in June 2006. My only issue was smoking and I quit in April, 2006. Like others on your site, the first side went fine. When the second side was started, I levitated off the table. I have had constant chronic pain in my testicles since. I cannot sit for more than 20 minutes without being in agony. I drive with my knees resting on the dashboard so that I can sit on the base of my spine. It’s a pain I can only describe as someone constantly squeezing my testicles. My pain level on a typical day is 6. The pain remains inside the testicles 98% of the time. I will get occasional shots up my groin but never down to my thigh. I rarely have pain during ejaculation. A Sitz bath instantly eliminates the pain 95% of the time, but only while I am in the tub. I’ve consulted 13 doctors (including my primary care doctor, urologists, anesthesiologists, and a various surgeons) with various specialties at this time, and have calls in to two more.I’ve been on many nerve blocking medications including Lyrica, Gabapentin and Celebrex. Gabapentin is the only one that eases the pain. Although by easing, I mean a 6 instead of 8. I have had steroid injections. I’m on my second pain clinic here in Boston. The first tried IV lidocaine, illioinguinal nerve blocks, medication, and spinals with no help. I had surgery with another urologist in November, 2006 to perform a skeletonization, granuloma cleanup and redo of the vasectomy. Yes, the first vasectomy never worked to add insult to injury. I left the hospital with a hematoma the size of a grapefruit and it was larger by the time I got home. In excruciating pain, I was rushed by ambulance back to Boston for emergency surgery to evacuate the 13cm diameter hematoma and was admitted for three days.

    The second pain clinic has concentrated on the genitofemoral nerve since day one. I did get two days of complete pain relief from the first block! Those were the first days with no pain in one year. Each subsequent block provided less and less relief. There were six blocks in all. During the last block, the doctor did note that manipulating the needle through the myofascial layer caused the most pain. It was a very sharp pain that caused me to jump. I didn’t know if this might be related to another email you received that referred to the psoas muscle. They have also performed a bilateral cryo-ablation of the nerves with no relief.

    The past 14 months have been a nightmare for me and my family. I’ve been on many different anti-depressants but continue to develop side effects when the dosage increases. I realize depression only makes things worse, but no one is giving me any hope. Tension is high. My patience is low.

    So, now I’m heading toward a bilateral neurectomy. I have calls into the Mayo Clinic in Rochester, MI and the Dellon Institute in Baltimore, MD. How I’m going to get there is another story because I can’t sit too long. I’ll worry about that when the time comes. I need to find the best.

    Does a neurectomy make sense as the next step after everything else I’ve tried? Another surgery scares my wife and me, but I need this to go away. I lost my job in March, 2007 and need to be able to get out there and interview. I’m not convinced a reversal would help me, nor is my surgeon. The surgeon who operated in November said the epididymus looked fine when he went in. There was no swelling so I don’t think an epididymectomy would help either. I was told that removing a testicle isn’t an option at this time but might be considered down the road. What to do?

    If this is posted on your site, I will come back with updates. It would be great if others could do the same to help the unfortunate victims down the road.

    Dr. Edward Karpman

    The treatment for post vasectomy pain (PVP) ranges from conservative treatments such as baths, anti-inflammatories and scrotal support to nerve blocks, denervation of the spermatic cord, vasectomy reversal and epididymectomy. It is hard to tell sometimes if the nerve block is being done effectively. If not, this will not cause any relief of the pain. My experience has shown that steroid injections do not give the diagnostic or therapeutic response that most men are looking for when seeking help for PVP. Injections using local anesthetics are much more effective in this scenario, but only if done correctly. If the nerve block with a local anesthetic doesn’t relieve the pain, then other causes should be considered. Referred pain to the testicle from another source would not result in any improvement after a spermatic cord nerve block. In this case, a more thorough evaluation should be sought.

    Oftentimes, patients with kidney stones will complain of testicular/epididymal pain which may be confused for primary pain originating from the testicle/epididymis. This is just one example that demonstrates the complexity of referred pain. Evaluation by a specialist with experience in dealing with PVP would be the ideal solution to this problem.

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