Has anyone had Microsurgical Denervation?

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Has anyone had Microsurgical Denervation to help with chronic testicle pain?

Seems like a better solution than removing the testicle but has potential issues given the nerves are tightly integrated with muscle, blood vessels and tissue.

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534 Replies

  • Edited

    I've been suffering testicle pain for what must be 12 years now, tried all the medications which only help a small amount. Its the side effects I cant deal with, so I only take Tramadol now and then, I don't seem to get any side effcts from Tramadol, thankfully.

    I'm due to go and see a specialist to discuss Microsurgical Denervation next month, my urologist referred me as she doesn't seem to think removing my epididymiss will solve anything.

    I myself reckon its a cysts that is causing my pain, I have a cysts on the head of the epididymiss, but urology say its too small to be causing the pain???

    I have to be real careful, I can only wear certain jeans/trousers, as most will aggravate the pain more.

    So are you going to have Microsurgical Denervation done?

    • Posted

      Thanks for the info. I have similar issues..inflamed testicle and epididymis with possible tissue damage either due to past infection or injury. Right side is about 2-3 times larger than left. Several rounds of antibiotics and high dose of Advil not working. Dr wants me to do several months of pelvic PT. If that does not work, then see a pain management specialist. Last option is removal of epididymis or entire testicle, which I am willing to do at this point.

      I cannot sit long (driving, work etc) or do much physical activity. Once inflamed takes a while to bring pain down.

      Was reading about Microsurgical Denervation as a better solution. There are short term procedures to see if it will work first, before doing the permanent solution. But all these surgeries in this area sound risky.

    • Edited

      Wow! your situation is so very similar to my problem, and I thought I was the only fella suffering this awful right side testicle pain.

      Doe's your right tesctle pain go down your right leg to your foot?

      Does your pain stop when you lay down for an hour or so?

      When you wake up in the morning is your pain gone, but soon starts once you get dressed, sit down or start walking etc?

      Have you had any ultrasound scans done, my scans showed two small cysts and some varicoceles. I was told these are too small to cause any discomfort, but I do have my doubts about that.

      When my pain first started I was treated for epididymitis, I was given antibiotics which did work, but once I finished the course the pain would soon come back.

      I first started to get right side testicle pain when I worked in the warehouse environment, I would be stood on my feet all day lifting heavy boxes, and by midday I would always get a dull heavy ache in the right testicle groin area which would go down my leg to my foot. The pain would get so bad that it would often cause me to limp, just as it does now.

      I have now seen urology three times, and they say they do not want to operate as they don't see anything sinister to give them concern. I have pleaded with them on all three occasions to either remove the epididymis, or the whole testicle, but they still say no. They say these types of operations have a high failure rate and will often leave the patient in worst pain.

      I was so ready for an operation, whip the dam thing off I thought. But the problem I have now is... I have been told so many times by different doctors that any operation can make the pain worst, that I have now become scared of having anything done.

      TBH, I really don't understand how one small testicle can cause so much pain, the pain is disabling at times, sitting, standing, walking, gardening, DIY is all so very difficult.

      I feel your pain buddy, there must be some help out there for us suffers.

    • Posted

      I have the same problem. The only drug that helps me is Percoset which is Oxycodone plus Tylenol. I take 2 pills and all the pain is gone for 24 hours which breaks the cycle for me until the next trigger which is sex.

      I also was given many courses of an antibiotic initially 2 years ago for my epididimytis. It was Cephalexin. It worked great for a few months but then it started to actually make my pain much worse. I think it started my nerve pain in my back which goes down my leg (sciatic nerve) and paralyzes me.

      It is all nerve pain which is the worse pain. Maybe you could ask for a Botox injection into the spermatic cord. I had that and it helped for several weeks. It only took a minute and was painless. Good luck.

    • Edited


      Yes, my symptoms are exact! I'm ok when I wake up but as soon as I stand and do anything it comes right back. For work, I sit all day and now I cannot sit more than a few minutes when spikes of pain set in. The pain can travel into lower ab, hip, down inside of leg, but mostly in scrotum. Pain feels like someone kicked me in the groin, but pain never went away. Everything is swollen and painful to touch. It is disabling as I cannot do much physical, drive, sit, staff meetings, social events. For work, I have stand up desk, and pack cooler of ice packs and elec heat pad to help get through the day. Have custom seat cushions, larger pant etc.

      This has been a 2 year journey full of misdiagnoses from a handful of doctors.

      1. First they said it was a UTI but test negative (have been tested 12+ times)
      2. Then they said it was enlarged prostate and told me to "deal with it" - it is normal for middle age men.
      3. Another dr diagnosed me with hydrocele, which I just found out a year later is wrong diagnosis.
      4. Another dr said it was prostatitis and overactive bladder and gave me 3 meds - did not help
      5. Another dr said it was epidimitis and took Cipro - did not work.
      6. After 2 years of this, now driving to big city hospital 5 hrs away and being diagnosed with both epididymitis and orchitis.

      I also want surgery, but keep getting told "no". No has mentioned the denervation procedure so wanted to throw that out there for feedback.

      Yes, also glad to find someone else with same issue. I have been scouring the internet for months and months without much feedback from someone that actually has what I have. Feels like a rare club.

      So currently being referred to a pelvic pain specialist, but they are very hard to find and many are "women only". Will be driving 10 hours for each appointment.

      Howard here is a big help!

    • Posted

      Hi Howard,

      Isn't the oxy stuff addictive?

      Have asked for different pain meds, but they tell me to use Advil for the anti-inflammatory. 2400mg/day is not reducing the inflammation.

      Thanks for all your valuable info! Feels like a rare club here.

    • Posted

      Hi gg,

      Oxy is addictive if taken to excess so you need to take it sparingly. Also the stuff you get back prescription is much better than the stuff you get on the street which really is addictive. Having said that, really and honestly when the severe back pain sets in from the swollen testicle I really cannot survive it. I thank God and my doctor I have the Percoset which lets me breath again after an hour. I do suggest you ask your doctor and let them know you understand the risks and will manage them.

      In the meantime, I got another article today by another urologist who specializes in scrotal pain. He actually invented the microsurgical denervation procedure. He lives in Chicago. I wrote him just now and asked if we can do a phone consultation. If you and We5t send me your email by PM I will send you this paper. It is worth reading - we are not alone. Good luck.

    • Edited

      Yes, Howard is very helpful, have you tried his home remedy mix? A number of spices mixed which kinda help to a small degree.

      What puzzles me about these urologists... is the fact they all say 'No' to surgery, they don't recommend surgery in this area, not unless they find cancer. If any of us was found to have testicle cancer, they would soon whip it off without question. But because they cant identify what is causing the pain, we are made to suffer, being turned away time and time again in excruciating pain. The cancer suffers tend to have a painless lump and are treated ASAP, they go on to live a good quality of life, and us testicle pain suffers are made to suffer where everyday is a living hell... its so unfair.

      I believe my condition is either these small cysts that I have, or the vaircoceles. I can pinpoint my testicle pain to the top of the epididymis, the pain somehow refers along the nerve and down my leg into my foot. My scan has shown a cyst on the head of my epididymis, so this makes sense to me, but they will not do anything about it???

      Its only because I have kept on and on to them, and explained to them I am at the point of being housebound, they are now finally referring me to a different hospital to discuss about Microsurgical Denervation. But I feel this will not work, I have read that if the pain is not localized to the testicle they don't recommend the surgery???

      I'm 47 years old, 6ft tall of athletic build, I don't smoke, I don't drink, I like to eat healthy, so why am I suffering like this? its crazy. 😦

    • Posted

      Have you asked them for a spermatic cord block? This is quick and simple and cheap - they just inject some Lidocaine into the spermatic cord to see if you get temporary relief. If you do then they say you are a good candidate for the denervation procedure. They can also inject Botox into the spermatic cord which acts to deaden the nerves for a few months. I had that done in April and it did help for a while. We are in the same boat - I am also house bound too. Ask them for a Percoset prescription - it is my only salvation and has few side effects. Send me your email and I will send you the paper I mentioned. Good luck.

    • Posted

      Hi Have you had that discussion now or was it all all called off with lock down . I thought my son was a bit better with new anti depressants but has been really bad last few days .In lots of pain and very angry .

    • Posted

      If you could get him on Percoset it would make a big difference. I've had a relapse this past week and am in terrible nerve pain but one Percoset gets me through the day ok. There are no side effects for me.

    • Posted

      Hi Sorry I havent replied your email went in spam. Our pain team is not very helpful they seem to prescribe the same meds to everyone .Pregabalin which hes had and didnt help and now he's on gabapentin .I'll ask but they hate me asking for anything .

    • Posted

      Hello Howard, I'm from Israel and suffer also from a chronic pain in my testicle and looking for a doctor for this surgery. How was your impression from the doctor you mentioned from Chicago ? Please write to me his details so I can contact him. Thanks, Yossi

    • Posted

      Hello Howard, I'm considering of the solution of removal the testicle from the groin (orchitomy), what do you think about this option and the risks that involved in it like phantom pain.

    • Posted

      Hello Yossi and Shavuah Tov!

      Orchiectomies are a last resort and should only be done as a last resort. Having said that the procedure is not a huge deal but the problem is that it may not solve your pain problem. All the nerves from the scrotal region pass through the spermatic cord and then on to the brain. Even if the original cause of the pain is fixed, the nerves in the spermatic cord have been so messed up and irritated that the pain signals will likely continue to be sent to the brain. It is similar to autoimmune diseases in this sense.

      When the scrotal pain becomes chronic it is best to forget about fixing the initial cause of the problem and focus instead on cutting the pain communication lines from the spermatic cord to the brain. This can be done with the MDSC procedure or by using Botox injections into the spermatic cord which chemically stops the signals from being transmitted to the brain. That only lasts 6 months and has to be repeated. The other option is to use a drug that turns off the pain receptors in the brain so you don't sense the pain. I've tried them all and they all ruined my life except for Percoset which I strongly recommend you try if possible. If you are careful with its use it should not be a problem. It has no side effects for me. Howard

    • Edited

      Hi I suffered chronic testicle pain for six months, had antibiotics, ultrasounds, gum clinic tests everything came back as normal. I was then put on pregabalin, gabapentin and amitriptyline from my local pain clinic, none of which took the pain away. I then went to international andrology London to see an andrologist who gave me a spermatic cord block which finally took my pain away for a few hours and he said this indicated I would be a good candidate for microsurgical denervation of the spermatic cord. I was about to have this procedure when my gp prescribed carbamazepine for nerve pain as a last resort and fortunately this worked! I have been pain free ever since! Hope this helps

    • Posted

      I had better just add my pain was in both testicles and the only relief I got was from lying down with an ice pack, I couldn't work or do anything much but am pleased to say I am now off all meds and experience no pain what so ever, I would have gone ahead with the procedure had the medication not worked though as success rates are said to be very good and the andrologist I saw (Dr amr raheem) was very professiona and reassuring.

    • Posted

      Any side effects from carbamazepine? Are you still on it?

      Congratulations and thanks for sharing.

    • Posted

      Hi Howard no side effects from carbamazepine fortunately and I came off them pretty quickly as the pain mysteriously dissapeared

    • Posted

      Hi Pauline I also found the pain clinic very frustrating, they gave me gabapentin, pregabalin and amitryptiline none of which worked for my testicle pain. I was about to have microsurgical denervation of the spermatic cord when my gp tried me on carbamazepine. This solved the problem and I am now off the drugs and am fine. Failing that contact Mr amr raheem at international andrology hospital London and he will be able to advise you if the denervation procedure is an option.

    • Posted

      Hi I also suffered from chronic testicle pain,after trying many drugs my doctor put me on carbamazepine which took away all the pain.prior to this I had a cord block injection to see if I could have microsurgical denervation of the spermatic cord and this worked( pain temporarily dissapeared) so I certainly would have tried this if medication didn't work. The andrologist I saw was Mr amr raheem who works at the international andrology hospital London 02031317133. Would definately be worth contacting, best wishes thomas

    • Posted

      hi Thanks so much for that .I will contact the GP tomorrow and ask about it ..

    • Posted

      Hi Thomas, Carbamazepine is also known as Tegretol, I was put on Tegretol some years ago and it didn't work for me. I like you was first started on Amitriptyline, then Gabapentin, and then Tegretol (Carbamazepine), the side effects just made me feel worst so I came off them. I may have not given the drug a chance to work properly as I couldn't stand the way it made me feel, but I believe all these drugs are pretty dangerous, as long term use of any serious drug ends up damaging the body anyway.

    • Posted

      Carbamazepine is also known as Tegretol Howard, I was put on this drug some years ago, the drug just turned me into a zombie. I would love to give the drug another go, but I've seemed to have developed a phobia over medications now, all because of the horrendous side effects they give.

    • Posted

      did you go ahead with Microsurgical Denervation?

    • Posted

      you probably have hypertonic pelvic floor. you need to see a sports injury Physical therapist

    • Posted

      I am the mom of a very active 17 year old son and we have had four months of hell as my son has been suffering from constant left testicle pain and swelling and after months of Dr visits, tests, medicines, etc, we don’t know where to go from here and was hoping that someone might could provide some insight.

      In September 2020 my son was hospitalized for a sports hernia and it was discovered then that he had a medium size hydrocele on the left testicle. According to him he had never noticed it and it never gave him any issues. We were told that we should just watch it and if it gets larger to visit the Urologist.

      My son is a cross country runner and during a sports physical in September 2021 it was determined that the Hydrocele was bigger and therefore we would seek a visit to the Urologist as soon as his season was over. It still never gave him any issues or caused any pain.

      In January of this year we saw the Pediatric Urologist (whom we love) and he decided that the Hydrocele needed to be removed since it was rather large. This is where it all went downhill. The hydrocele was removed on January 11. The Dr said surgery went very well but it was mentioned that there was a lot of inflammation in the testicle which was not expected and he was not sure what from. My son had normal surgery pain but even after a week or so was staying in a lot of pain on the bottom side of the testicle. It hurt to walk, sit, touch it, etc. He was given Oxycodone for after the surgery to help with pain and it did not even touch it. After much conversation and several appts the Dr went back in on February 10 to see if something else was going on or if something was missed. The Dr said that the testicle and cord appeared congested and therefore the stitches from the previous jabalay closure along the testicle and cord were released which to the Doctor instantly made it feel better. A small hematoma was also found which was cleaned up. We prayed these were the answers to his pain. A drain was put in for a week and Keflex was started. There was the expected surgery pain which then went to the entire left side of the testicle where the incisions had been made.

      This is where we are today. The entire left side of my son's testicle is extremely sensitive to any touch and just excruciatingly hurts in general. It hurts him to walk, sit or stand. The only “somewhat” relief is when laying down. It is still extremely swollen. We have been on so many medicines and he is still on some - currently on Doxycycline, Gabapentin (300 mg 3x), Flomax, 800 mg Ibuprofen and just finished another round of Prednisone. We have done three nerve blocks - the one directly in the testicle provided no relief, while two given in the left hip area provided very mild relief for 4-5 days. He has had several ultrasounds done (blood flow is great) as well as a CT and MRI. We’ve done blood work and everything is normal. His Doctor has consulted with many other Urologists and Surgeons and we have tried everything that has been thought of. They are all completely stumped and say we might just have to give it time. We are being referred to pain management which we go to on Friday to see if they can provide him with some better relief which I am okay with only if we are actively trying to figure out what is going on. We went for a second opinion two weeks ago and this Urologist agrees with everything that has already been done and said time and/or removal of the testicle or denervation are the only options really. My son says to sign him up for the surgery to remove it but that is not even guaranteed to take away his pain. It is obviously very hard to make the decision to remove a testicle and are of course concerned with fertility although we have been told has no effect in the other testicle. If I knew that it would 100% take his pain I would not hesitate since that is what he also wants to do and we have been going through this for four months with no improvement.

      My first thought is to try the denervation procedure, however, it would not help with the swelling and I don't understand why the first spermatic cord block that was in the testicle did not provide any relief while the other two in the hip area have given some. I hate to do this procedure and it not work and wonder if we just skip it altogether.

      As I said, my son is 17 yrs old and has had his life drastically changed since January. He is very active and cannot go to school, run Track, go to church, etc so we are at our breaking point and do not know where to go from here.

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