Has anyone had Microsurgical Denervation?

Absolutely yes! There are nerves that go from the testicle through the spermatic cord and then up through ilioinguinal canal and from there over to the lower back and the sciatic nerve. If these nerves become chronically excited then they can cause terrible lower left or right back pain and pain down the legs from the sciatic nerve. This is what happened to me. i could tolerate the testicular pain but when it hit my sciatic nerve I was paralyzed. Only Percoset helped me survive the pain. Then the Botox injection into the spermatic cord has really helped me now for 4 months where i do not get the sciatic nerve pain. It is a blessing. Good luck.

Thanks Howard, That is what I thought, and Yes! the pain down my legs into my feet is worst than the testicle pain, I can put up with the aching, but not the pain. The trigger point which starts the pain seems to be in my testicles though, so what could be causing the nerves to fire-up and effecting the sciatic nerve?

Yes exactly! I have not had the denervation procedure yet because the Botox injection has really helped me a lot. It is supposed to last for 4 to 6 months and I am at 4 months now. Sometimes I do get testicular pain and I just take some Advil but the Botox has kept the nerve pain from going into my left lower back where it hits the sciatic nerve and knocks me out, That was why I had to take Percoset but now I haven't had to take even one Percoset pill for at least 2 months. Hopefully you too can get the Botox injection. It is the same procedure as the nerve block injection and no side effects. We have some good options for our pain.

Hi Howard, I never get pain in my back though, just my testes, legs and feet. Starts as a dull heavy ache, but soon turns into agonising pain. I'm due to have a CT scan the first week in September, it was originally going to be a MRI, but now they want to do a CT scan instead. I will mention to the urology specialist about the Botox injection, depending on what they find on the CT scan.

Hi my 15 year old son has been prescribed duloxotetine pregabalin and morphine. He is experiencing periods of temporary blindness which we think is caused by the Duloxotetine .Has anyone else used this medication .They wont consider anything else until he had been on it for 6 weeks also his CT scan hasnt come back yet .

I had my CT scan yesterday with intravenous contrast dye injected into my veins, this dye had a adverse effect on my testicles and leg pain; once the CT scan was over I had tremendous pain in both testicles and in both legs. I had to limp back to the waiting room, this would indicate the injection of the contrast into my veins would have highlighted a weakness; a blockage, narrowing of veins somewhere in my body e.g testicles. I still have the pain today, more so on the right-side. I just hope the problem has shown up on the scan, I will know once I get the results.

Did you discuss this reaction with the technician or a doctor? It sounds like it could be an allergic reaction to the dye. Try taking an antihistamine to see if it helps. Good luck to you.

Hi Howard, I had my follow up appointment today with the urologist, my CT scan results have come back normal; so the doc tells me there is not much he can do. He says because I didn't respond to the ilioinguinal nerve block straight away, he reckons cord denervation will not work; a less than 50% chance of the operation working. However, he has decided to book me in for a Varicocele Embolization, this is obviously less invasive and could be the answer to my pain. I have varicoceles in both testicles, 1.8 and 2.5mm in size (grade 1&2), so these could in fact be causing all my pain and discomfort. Has anyone here undergone a Varicocele Embolization procedure?

Hi We5t

I had a varicocele embolization 3 years ago to see if it would help with my scrotal pain but it actually made things much worse! It is better to get it done by an interventional radiologist who does not use coils than a urologist who just cuts the gonadal veins.

But in our case where the pain has been going on for a long time and has become chronic, the nerves in the scrotal tube have become so inflamed that removing the original source of the problem doesn't work any more, whether it be varicocles, epididimytis, or even removing the testicle itself.

Your varicoceles are not that high a grade at 1 and 2 and I doubt they are causing your problem. I would ask for a second nerve block attempt as sometimes the lidocaine doesn't go where it is supposed to. Also ask for the Botox. I am at 6 months and it has made a huge difference. I will get a second one in 2 weeks as I am at the time limit for it to work. Also there are some topical analgesics you might ask about where you just rub the cream on the outside to get relief. I hope to be part of a study for this.

But still for us the only real solution for the long term is the denervation procedure. It is worth a try even if it doesn't work.

Thank you for your reply Howard... I haven't been told as yet how they will perform the varicocele embolisation, my urologist has said he will refer me for the embolisation; I've only assumed they will use plugs/coils to seal them off. I read this procedure can make things worst, as you say. I've read the coils can migrate and move along the veins and cause all sorts of problems, this has put me off... My other urologist did say to me that she 'wouldn't' perform a varicocele embolisation, because it can make the pain worst; she said my varicolceles were small and not worth putting me at risk. But this new urologist I've seen who is my second opinion is referring me to have it done, he reckons it may work; I'm at the stage now where I don't know what to do for the best...

I really think the denervation procedure is ultimately the only permanent remedy for us. I myself have had all the pain return this weekend so i will have a second botox injection next week. But if that doesn't work I will have the denervation procedure.

You should request a second cord block injection and just tell them that it did relieve your pain this time for a few hours. Those screening injections are not perfect and can often miss the nerves that are causing the pain. I know men who did not respond to the cord block test but still had the denervation procedure and were cured . Forget going after the original cause like varicoceles as it will just make things worse and delay fixing it. Good luck.

Do you have varicoceles Howard?

I had varicoceles on both sides and had an interventional radiologist fix them 3 years ago. At the time I had already been suffering from chronic scrotal pain for several years on the left side only. He fixed the right varicocele but the left one actually got worse because other veins opened up to compensate for it and my pain got much worse. Both he and my urologist agreed it was the wrong thing to do because the nerve pain in the spermatic cord is chronic and will continue regardless of treatment. I am in a bad way again after nearly 6 months to relief from the botox injection. If the 2nd one doesn't work I will get denervation procedure.

Sorry your pain has got worst again, its crazy how two small oval objects can cause so much pain and discomfort isn't it; everything in this area is such a design fault... This new urologist I saw here in the UK specialises in cord denervation, he said that its still a new procedure and it doesn't always work, and they don't know enough about side-effects. He also said there are nerves that they cant see, he says I have less than a 50% chance of it working. I really don't know what to do anymore, I'm not even sure I want the varicocele embolisation done; everything seems to risky.

So micro denervation can help with pain caused by varioceles?

To date, I have not found a med that helps with scrotal pain. A pain specialist gave me nortripiline for nerve pain, but did not help. I was asked to increase dose but side effects were more then I wanted. And all the Advil and Tylenol in the world do nothing for me.

After learning about varioceles, see the only solution is surgery and confirmed by issue knowing that meds cannot relieve this type of pain.

Can you get Percoset for your pain? Honestly it is the only drug that works for me and I have tried them all. I am careful with it - usually just one pill and i am good for 24 hours.

A 50% chance with the denervation is very good odds. The side effects are very minor and not even worth mentioning. If you decide I can help with that.

It is a quick procedure, only 30 minutes with a rapid recovery and no scars. You should go for it. What about Botox injection?

Have you been told the size of your varicoceles gg78506, they grade them 1, 2, 3 and 4, do you know the size 1.8mm, 2.5mm 3.0mm etc?

My sons CT and MRI scan results came back normal and as he didnt respond to the nerve block the urologist has discharged him .Feeling so desperate now .Where did you get the botox block ? Im hoping to get a second opinion but dont know where to start .No pain killers help nor the pregabalin .He has been taken into A&E again with pain but nothing seems to happen .He is seeing a psychologist and the pain team seem to think the pain is psychological which it isnt .

I requested the Botox from my urologist. Actually he suggested it and told me it helped his patients a lot from 3 to 6 months. If your doctor will not provide then ask where you can get it done. It is a very simple procedure - same as the cord block injection and with no side effects. I also did not respond to the initial cord block with lidocaine and bupivacaine but the botox started to work after 6 weeks and then "cured" me until now after 6 months.

Also I tried all the drugs and none worked expect for Percoset and it has saved my life. Both my urologist and family doctor prescribed it to me after I was given a lecture on how to manage its use so i do not get addicted. Again, if your doctors will not prescribe it then find a doctor who will. For me it was and continues to be a miracle drug and it has no side effects for me except a little itching. I can take up to 6 pills a day if I need to but have never needed more than 2. It takes about 3 hours to fully work. You and your son do not need to suffer from this. There are easy remedies if you can just find the right doctor. I live in Canada. Good luck. Howard

I forgot to mention that my CT and MRI scans also came back clear which means absolutely nothing as we are dealing with nerve pain which doesn't show up. Request another cord block and tell your son to say that it really helped so they schedule him for a denervation procedure. Cord blocks also are not perfect diagnostic tools for this problem.

No. The MRI report only said "moderate". I will see dr in a couple weeks. Or maybe I need to be referred to another specialist just for this??

Has your son had an ultrasound scan, I would imagine he has, did they find anything? Does your son get pain down his legs? There is one thing I will say about treatment for testicle pain here in the UK, and that is... its non existent. Doctors and urologists seem to think the patient is making it all up, that the pain doesn't exist; or that you are exaggerating. One urologist I saw also suggested its psychological, its disgusting how we get treated here in the UK; the NHS really doesn't work. My latest urologist has said I may need to see a neurologist, says its nerve related, well of course the nerves are being effected; something in the testicle is causing the nerves to react. I can 100% say the trigger point for my pain is the testicle itself, as soon as I put on jeans/trousers my ache/pain starts, the seam of the jeans/trousers only has to touch my testicles and this triggers the pain. My ultrasound scan has shown I have varicoceles and cysts on both testicles, one cysts is on the head of the epididymis, but they say its small less than 2mm. I'm due to have the varicoceles sorted, but I'm in two minds on whether to have them done or not. I believe these doctors don't know enough about testicle pain, they rather not operate as they say this can leave the patient in more pain; that is what I have been told by them all. Ask your doctor about Tramadol, its a pain killer, its the only one that helps me at present, good luck.

I forgot to mention, does your son's pain go or get better when he lays down, does his pain get worst with walking/exercise. If it does, its more likely varicoceles, blood flow to and from the testes.

I'm on my second opinion, this gave me a CT scan which came back clear, and now he is sending me to get my varicoceles sorted. He did suggest about a second nerve block, but then changed his mind and tells me to see the pain team again. If the varicoceles are the problem, then great, but it just seems to easy for it to be the case after all these years; I'm hoping and praying it works.

Hi Howard, I take Tramadol, this does help, side effects are that bad either, thankfully. I'm hoping my pain is caused by the varicoceles, because when I list the symptoms , they all point towards varicoceles. When my pain started it was when I was working in the warehouse environment, I would be standing on my feet all day and lifting heavy boxes, and by the afternoon I would get the pain in my testicle and leg. The condition has got worst over the years, walking/standing and any type of exertion starts the pain or makes it worst, and laying down will stop the pain (this all effects blood flow). When I had my CT scan a few weeks ago, I had a intravenous injection of contrast dye into my veins. This made both testicles and both legs and feet hurt like hell, all at the same time, so we reckon the injection increased the pressure through my veins which swelled the varicoceles; we cant think of any other explanation...

Well it might be worth a shot but I strongly recommend you find an interventional radiologist who will embolize both varicoceles without coils. If you use a urologist it is a major surgery where they put you to sleep and then open big cuts and just cut the gonadal veins. The recovery is long and painful and most of the time the varicoceles come back over time. But an interventional radiologist does none of that and there are no cuts or recovery time and if he is skilled without coils he will close any collateral veins that could form bypasses in the future and cause the varicoceles to recur. That would be worth a try. I did it a few years ago hoping as you do but not only did it not help but it made my scrotal pain much worse.

Did you have the coils, did they say why the pain got worst?

No - the IR used pressure until the veins were destroyed but some sclerosant got into the scrotum which made the pain worse. He did not have much experience which is why it is important to make sure your IR has done a lot of varicocele procedures without coils.

I've just had a eureka moment, I've just discovered the trigger point to my pain. I can recreate the pain by grasping at the spermatic cord, using my finger and thumb I press/squeeze the spearematic cord through the skin of the sack, I can feel the spermatic cord which hold the blood vessels/nerves etc. I done this the other day which immediately started the pain, I felt the exact same pain in the testicle, down my leg and into my foot. I started to massage the spermatic cord to see if I could help push the blood through, today seems to be a much better day, no pain at present. I wonder if this is the root cause to our problem, blockage/swelling of the spermatic cord?

That is great and you are correct. For those of us with chronic scrotal pain the pain does originate in the nerve bundles contained within the spermatic cord. These nerves are just hypersensitized to the point that any small thing can set them off firing their pain signals to the brain.

So I think you proved better than any nerve block that you would benefit greatly from the denervation procedure.

I am just starting my long drive to Toronto now for my second Botox injection into the spermatic cord tomorrow morning. The last one lasted 6 months and gave me my life back but for the past few weeks I am back on Percoset. I hope the second one helps as much but if not I will get the denervation procedure.

Forgot to mention that your experiment also shows why trying to fix the original cause of the scrotal pain like varicoceles, epididymis etc will not help us at this point because the nerve bundles in the spermatic cord are all shot at this point.

Hi Howard, I'm not sure I quite agree. My testicle pain resets itself every night/morning. Each morning I wake up and I have no ache or pain what so ever; its bliss. But, as soon as I start the day by getting dressed, walking or sitting, the ache starts which then turns into pain; This is a daily repeat process for me... Does your pain stop when you lay down?

We5t - Check out symptoms for Varicoceles. It does mention that laying down helps, and slowly increases in pain as the day goes...and aggrevated with physical activity, prolonged sitting, standing etc.

I have similar symptoms and sucks when the best thing is lying down with ice packs and compression shorts. Swimming helps too. Have had several ultrasounds, but was not until I had a MRI that the varioceles were discovered. Although my dr still is putting all the attention on epididymitis.

Yes - mine does get better too when I lie down. Often I don't want to get up in the morning because I know the pain will start again.

There's no problem getting your varicoceles fixed but you don't want to make the problem worse. So from experience I recommend ONLY an interventional radiologist who has experience doing this without the use of coils. A urologist will surgically cut the gonadal veins which may provide temporary relied but in most cases they regrow in time. And coils have been implicated in a great many nerve pain problems which is what we are trying to fix.

Hi gg78506, Did your MRI show epididymitis, was your epididymis swollen or damaged? What does your doctor want to do, are you on antibiotics or anything?

Hi Howard, That was my concern, will the coils press on the nerves and cause pain? Obviously the coils are just sitting there in a vein, you would think the coils would be the same as having blood pooling in one place. Its a real big worry of mine, but I'm not even sure what varicocele procedure I'm having yet, I've not had the appointment through. My urologist said two weeks ago that he will refer me to get the varicoceles sorted, that is all I know for now. I was told that varicoceles if left can cause all sorts of problems, testicular cancer being one.

I forgot to say, I was meant to have an MRI, but they swapped it for a CT scan instead, said they wanted to scan the veins and nerves etc (they didn't scan my testicles because of the radiation involved). They told me ultrasounds are better at looking at the testicles, this is when they found the small varicoceles. They said no need for MRI because ultrasound is better. But I read that MRI is better at looking at the testicles, so I'm really annoyed with them.

Hey Howard, I just got hold of my ultrasound report, its states... Arising from the head of the right epididymis there is a 1.8mm cyst. Bilateral varicoceles noted, the largest noted on the left side measures 3.1mm.

I also have a cyst on the head of my left epididymis but it cannot be removed unless the epididymis is removed which is very difficult to do. I actually had reconfirmed yesterday during my botox injection. The varicoceles are very small but if you can get them taken care of with minimum risk it might be worth doing anyway. The only benign method I know of is an IR who does not use coils and has done many many of them. I think you would benefit from a botox injection at the head of the epididymis. That is what I had done yesterday.

I will have to inquire about the botox injection. I now have another ultrasound scan booked and consultation for next week at the hospital who is going to do the varicocele embolization, I will take my results from my previous scan with me so they can see the 3.1mm varicocele, just incase the next scan shows smaller... Howard, what happens to the testcle when it comes to sperm production once the epididymis is removed, surely the testcle itself will still want to produce sperm, so where is the sperm stored if the storage chamber isn't there?

You are correct because the epididymis acts as a conduit for sperm from the testicle up through the ejaculatory ducts into the prostate so its removal would render that side infertile. But most men are still fertile even if the testicle is removed as long as the other one is healthy.

Anyway removal of the epididymis is a painful difficult surgery and rarely fixes chronic scrotal pain so you should not consider that as an option. I think the only long term option for us all is the denervation procedure.

Hey Howard, can the varicoceles cause aching/pain that goes down the leg and into the foot?

Yes exactly. Varicoceles and other chronic abnormalities in the scrotal region cause nerve pain in the nerve bundle in the spermatic cord. That nerve pain can propagate along the lower back over to the sciatic nerve that runs down the legs causing the pain you describe. That's the pain that really cripples me - even more than the testicular pain. My botox injection has triggered that pain down my left leg for a few days which is normal but I am laid up in bed on percoset not much fun!

That makes so much sense, and YES, the leg pain and foot pain is worst than the testicle pain. When my condition started 12 years ago, all I had was a dull heavy aching in the right testicle. Then within the first 12 months I started getting the aching down my leg and then down into my foot, this then got painful and has stayed with me ever since. The dragging ache/pain down the legs and into the feet is crippling, far worst than the testicle pain itself, and it all starts from within the testicle, unbelievable really.

Something else I was going to say, I don't want to put all my eggs into one basket just yet, but I've had 3 days of hardly any pain. I know this may sound pervy, but I've been massaging my testicle, sperm cord and veins these past few days and it seems to have stopped the pain. I can actually feel my two epididymal cysts at the top of my right testicle, I have been pushing and rubbing, also grasping at the cord. I remember reading sometime ago about a patient going to his doctor who massaged his testicle in this way and his pain went, does it help push the blood through, maybe it moves the nerves and veins once pushed or pressed?

We can scrap the above post, I spoke too soon, massaging the testicle and cord doesn't work. The first time in 3 days I'm in horrible pain again, I reckon I've just had a lucky few days, but now its all back to normal 😦

*normal? I wish it was back to normal. I've had this pain for far too long, the pain feels normal to me now, I so wish it wasn't.

But I think you are correct that changes in blood flow can alter the nerve pain. When I get migraine headaches I massage the site on my head where it hurts and that does help with the pain.

Here is something else I discovered. When my scrotal pain is very bad I noticed that if I get a full erection and hold it then the pain goes away completely. But once the erection goes down the pain returns. You would think the last thing you want with this pain is an erection but it does help. I told this to my urologist once and he said that some doctors give the men Viagra just for that purpose and it does seem to help for some men. Viagra can give long-term erections for many hours. All erections do is to change the blood flow around the scrotum so I think you are correct about your massaging. Too bad you cannot get some Percoset. It has saved me this week after my botox injection.

I had flu (influenza A) last year, and the testicle, leg and foot pain stopped for seven whole days. My blood pressure dropped very low, I even passed-out one night, so we reckon the pain stopped because of the low blood pressure. This morning I am still in pain from yesterday, as soon as I got dressed this morning the pain started again, blooming horrible it is.

Can anyone wear a belt? I have found wearing a belt makes the pain worst, seems to pull the trousers up around your nuts when you sit down.

Don't know about belts - I never wear one. You should still continue the massage therapy you did earlier - it may help you again. It is funny about the blood pressure dropping and helping the pain. That is what Viagra does - it was originally developed to help people with high blood pressure. Maybe you could get a sample from your doctor and see if it helps with the pain?

Sometimes when I get an erecting it makes the pain worst, and having sex can sometimes make the pain worst, and other times it can relieve the pain (not set pattern), but I think lately having sex has triggered the pain much more than usual... I've been reading up on the varicocele embolisation using coils, seems many patients say it has made the pain much worst Howard???

Yes - coils can and do make it worse sometimes. There is a forum devoted to this problem with coils which is why I suggest you find an IR who has a lot of experience without coils.

But honestly I think ultimately the only solution for us is the denervation procedure and all this other stuff is wasting time. We should not suffer so much when there is an easy procedure with a good chance to fix it. I suggest you find a doctor who will recommend it for you. I too am tired of watching all my days in pain so if the botox wears off again that is what I will do too.

I agree, but the doctor I saw last month who performs cord denervation said he wouldn't do the procedure, said I have less than 50% chance of it working. He said there are nerves which they cant see, said it doesn't always work. Living here in UK is hopeless when something like this happens, because all the doctors are hopeless.

Hey Howard, Do you know how varicoceles makes sitting down worst?

Sitting makes the blood pressure in the veins greater which causes the pain to increase. So does standing. that is why we are good lying down. If you took your BP standing, sitting and lying down it would be lowest lying down. One way you can see this is by performing the Valsava maneuver where you hold your nose and push really hard. You can actually see the veins on the testicles dilate a lot. That is what the radiologist does during the scrotal ultrasound to really see the varicoceles.

Living in Ontario Canada isn't any better as we don't even have access to private pay options. You just have to insist on what treatment you want or get another urologist- hopefully one that specializes in scrotal pain. I think a 50% chance of it working and curing us is excellent. Even removing the testicle and the epididymis is only 70%. You cannot go through life with this pain!

I've asked two urologist to remove the right testicle, and both said they wouldn't do it, because they cant be sure the pain isn't coming from somewhere else in the body. They said we would have to remove both, as I get pain both-sides, omg! can you imagine having no balls, this then would cause more problems they say. I've even said to them I wish I had testicular cancer, so at least then they would have to remove the testicle/testicles. Medical science can do some wonderful things, saving lives etc, but they cant fix out testicle pain, why? Cord denevation seems to be the best option as you say, but I cant seem to get it done, as its a new procedure and not enough is known about it here. I have another ultrasound scan tomorrow, this is with the varicocele specialist who wants to do a scan. I'm hoping for a miracle, but something is telling me they/he/she will say the varicoceles are too small, even though my last scan was a few weeks ago which showed a 3.1mm varicocele. Hopefully I will know more about what procedure they will offer, that's if they offer anything 😦

I've just got back from the ultrasound scan, they say I have small varicoceles on right side (even though that is the side with the worst pain). They say my left side testicle has the larger varicocele (pain on left side is left often though) I just don't get it??? But Doc did say he will do a varicocele embolization on both sides, he was very positive, he reckons my case is typical of varicoceles. Basically he said he will go in through the neck vein and down to the testes and seal off the varicoceles using mesh type coils, and inject a substance to kill the vein, he said new veins grow back. My worry is, I've read many cases where this procedure may make the pain worst, but I've also read the procedure does actually work, and the patient is pain free.

Mine was also done through the neck jugular vein. It is quick and easy and no pain and you can watch it on the monitor as you are fully awake. I think it is worth doing, even with coils. In my case it made the pain worse but many men have been helped too. When can he do it for you?

Hi Howard, I understand you didn't have the coils, do you think that is why it didn't work for you? Can you not have it done again using the coils?

To confirm whats the difference between this coil/mesh method and the other method you mention?

Interventional radiologists insert tiny coils at the bottom and the top of the vein they wish to embolize and then inject chemical sclerosant in between to destroy the vein. The coils keep the liquid sclerosant from going where it could cause trouble like the scrotum or kidneys or heart. But the coils are metal and remain in the body forever. Sometimes they migrate and can attach to nerves and cause terrible nerve pain.

Most European IRs now do this procedure without coils. They simply apply physical pressure to block the sclerosant while it is destroying the target vein. This usually takes 5 minutes. I tried to find IR here who could do that for me. Only one said he could do it but he had never done it before. He let sclerosant into my left testicle 2 years ago which ironically has caused the very scrotal nerve pain I was trying to avoid!

I can but my IR and urologist told me that years of chronic scrotal pain have ruined the nerve bundles in my spermatic tube so fixing the varicocele wouldn't help with the pain. I even said to use coils since it can't make the pain worse but they declined.

So are you saying the IR did the procedure (without coils) incorrectly? I'm surmising they did, due to the sclerosant got into your testicle.

Also, that if we do go down the pushed down the embolisation route, we should do our utmost to elect the non coil method?

Is there a higher risk of sclerosant leakage with the non-coil method?

Hey Howard, If you have nerve damage, surely you would have pain 24/7, your pain wouldn't go when lying down. The fact you say your pain goes when you lay down is typical of a varicocele problem, blood circulation/valve problem etc? If your pain starts or increases when sitting or standing or any type of exertion, this shouldn't relate to nerve damage should it?

Hi Mr Jim, and I'm meant to be having my varicoceles embolized using the coil method, you've got me worried. 😦

The other worry I have is, the fact that I have two small epididymal cysts on the head of the epyididymis, I have always thought these are the cause of the pain???

Can you not push for the dernervation surgery?

I thought you'd had a cord block?

As Howard has mentioned, push for the denervation surgery, it's the nerves that are the issue. The nerves generate the pain.

Howard Please can you tell me what type of botox was used or any more details .I may have found someone to help with this .