Has anyone had Microsurgical Denervation?

Does it seem odd to anyone else that it seems like a lot of us who have testicular pain also have cysts? Have any of you guys ever talked to your doctors about possibly draining them with a needle, because from what I read on the internet that is one option of dealing with this. I guess the cysts are just sperm that got clogged, but in my case I think my cyst is inflamed because it is hard as a rock and burns to the touch.

Here is my suggestion to you : request a cord block to "test the waters" as you say. That is just a simple injection of lydocaine into the spermatic cord to numb it for a few minutes, REGARDLESS of what you feel or don't feel, tell them it gave you relief from the pain for a few hours. This will qualify you for the MDSC procedure which is what you need given your symptoms. The cord block test is not very reliable but the doctors seem to rely on it for screening for MDSC so just play along and you will be ok.

Thanks chap, yep definitely going in that direction.

Also, thanks for you advice the type of embolisation, I've located interventional radiologist if I do go down that route.

Hi gg78506, Did you have a cyst removed, was it a epididymal cyst, did it not work?

Hi Mr Jim, Did you have a cyst removed, was it a epididymal cyst, did it not work?

I have two cysts, however the pain I'm experiencing is sharp and bilateral, I also get leg and lower back pain. I believe this to be symptomatic of varicosele. So to answer your question, no I have not had them removed.

I also benign cysts on the head of my epididymis. I've had them my whole life and never had a problem until these past 2 years since my procedure. The problem now is that the nerve bundle in e spermatic cord is so upset that any little irritation sets off all the nerve signals causing pain. I am especially susceptible to stress of any kind. For me the denervation procedure will be like cutting the phone lines between the irritated nerves and my brain rather than going after the caller itself. I would say the caller is on automatic now like a robocall! But I think it is worth your trying the varicocele procedure. If it works great but if it doesn't maybe then they will set you up for the MSDC procedure.

Hi Jim, I have two 1.8mm cysts located on the head of my right testicle, the urologists tell me they wouldn't be causing my pain, but how can they be so sure? I also have bilateral varicoceles, the largest is 3.1mm which is on left side, but the aching/pain is far worst on the right side, the smaller of the varicoceles, strange really. I live in Dorset UK, and its really hard to get treatment for testicle pain, no doctor wants to do anything. 😦

Hey Howard, I had my follow up with the pain clinic today, saw the doctor who performed my Ilioinguinal nerve block, he said he can now give me a ultrasound-guided pulsed radiofrequency ablation nerve block. He said its another Ilioinguinal nerve block with a pulse/probe to zap the nerve, he said he has had good results in the past, but mostly short term. I told him I'm to have the varicocele embolization, and should I not go through with it... He reckons the embolization is the better way forward, he said if it doesn't work, to go back to him to have the radiofrequency ablation.

Sounds like you have some good options. Did you ask him about Botox and also prescribing Percoset for the pain?

Sounds like what I'm going through. Have A small hard cyst that whenever I press on causes worse pain. I guess doctors just don't want to believe these things cause pain. I think I might try Acupuncture, or now that recreational marijuana is legal here in Illinois I might try that also.

Does anyone know, when the varicoceles are embolized, do new veins grow back?

I had acupuncture on Wednesday morning, needles went into my right thigh/buttocks. I was told at the time it would increase blood flow and by god did it not. I immediately got a hot somewhat painful sensation going down my right inner groin and into my right testicle, this followed with relief and comfort. My testicle and testicle skin felt different once again (better different). The relief last for about 8 hours and then pain returned. I hasten to add that I know it would be short lived, however I didn't expect the sensation in my right testicle. The vast majority of my pain is right side, albeit the sharp testicle pain can be bilateral.

Yes - in most cases they do regenerate . They regenerate by developing bypass veins also called secondary veins and collaterals. This is one of the problems with the urologist just cutting the main gonadal veins because there often are secondary ones that pick up the slack. A good IR will look for secondary veins that open up when he kills the main ones and then embolize those as well while you are still there.

Hi jon55953, Do you get ache/pain down your legs, or into your feet?

Hi Howard, My new urologist has now confirmed that they will embolize the varicoceles (both sides), and if that doesn't work, they will look at removing the two cysts at a later date. I am very happy to hear this, but at the same time I am really scared. I don't want to end up in worst pain, or have some wired side effects, what if my balls don't work properly after the embolism?

Don't worry about that - I've never heard that one! So you are going with the urologist rather than an IR?

oh sorry, yes its a IR, the urologist referred me to the radiologists, I'm just waiting for the date now.

That is good to hear - please keep us informed.

I sure will Howard... I wonder why they agreed to do the varicoceles first and not the cysts as yet. My varicoceles are small, you cant see them on the outside, so what if they are not the cause to my ache/pain... It could be the two cysts that are the problem... What a awkward situation to be in... 😦

Cysts are very difficult to treat as they are grown into the tissue. It is not like removing a wart on your arm. My doctor would not treat my cysts as he said it was too risky. I think you have a good plan of action. Maybe it will solve the pain for you.

I'm just so worried I will end up in worst pain if I have the varicocele embolization, I thought it maybe best to have the ultrasound guided pulsed radiofrequency ablation nerve block instead.

The pulsed radiofrequency ablation nerve block is where they perform a ilioinguinal nerve block by injecting local anesthetic into the nerve, they then insert a radio frequency needle close to the nerve, then insert a radio frequency electrode through the needle. A small electric current is then passed to test the position of the needle, then the electrode is heated to 42 degrees centigrade to stun the nerve, preventing it to send pain signals to the brain. Its not a guarantee fix, it can take upto 6 weeks to work, and may only last one to two years, may not work at all. Seems less risk involved than the varicocele embolzation, I don't fancy permanently blocking my two main testicle veins with coils, surely this cant be good for the testes, the flow of blood must drain at a lot slower using the other small nerves within the spermatic cord. I've read so many horror stories about varicocele embolization, it seems to have put me off from having it done. 😦

Hi We5t,

Sorry for the delay. If it were me I would try the pulsed RF method first before the VE. It is one of several new experimental efforts for scrotal pain that has few side effects from what I read. Included in that category is botox and topical analgesics both of which I am trying. The RF method was not offered to me but if you can get it soon that would be my choice. You are correct to be wary of the varicocele embolization procedure, whether done by an IR or urologist.

Hi Folks, It seems we are damned if we do and damned if we don't, surgeons rather not perform any procedure. All the procedures we have discussed here are risky, the cord denevation is the most risky. My urologist who is a surgeon and does perform cord denevation, he said ''there is not enough known about the procedure'', he said he would rather I have the varicocele embolization done. I'm beginning to think I don't want anything done now, the fear of being in worst pain really does scare me, but at the same time I cant go on like this, the pain I have now is too much to cope with. This is really getting me down, I cant do anything without being is pain, I hardly go out anymore, I am pretty much at the stage of being housebound. I'm only 47 years of age, 6ft tall of slim build, I like to stay fit and eat healthy, I don't smoke and don't even drink, so why is it that my testes are killing me, literally. I don't know what to do???

@We5t

I have been told the same by a handful of urologists too, but I am not taking "no" as an answer.

Part of me wonders if these surgical procedures are not taught in medical school and left to the specialists of specialists who are willing to push the envelope. It seems like most specialists focus on kidney, bladder and prostate, but not into the scrotum.

I have been through a dozen doctors now in the last 2 years and have been misdiagnosed all along with you name it, including overactive bladder, enlarged prostate, STD, infection, UTI, hydroceles, all with different meds and ends up EVERYONE has been wrong. Have had 2 ultrasounds that were even dis-interpreted which delayed the whole process. Has proven the lack of knowledge and experience when it comes to the inner workings and related issues in the scrotum. It has been a long and frustrating experience, as you know.

Think we need to leave these procedures to the "specialists of the specialists", someone who knows these procedures inside and out and has a good record of doing such.

But getting back to your post, having variocele embolized may be the quickest and least risky procedure to start with and go from there.

Hi gg78506, thank you for your post. I keep saying that to my self, but I like you have been told so many different scenarios, I don't know what to think anymore. My GP told me not to have anything done, the first two urologists also told me I could end up in worst pain if they were to perform a varicocele embolization, they said my varicoceles are small, and the pain I feel might be coming from elsewhere in the body. The second urologist is the one that referred me to the third urologist who specialises in cord denevertion, he was the one that said the procedure is new, and not enough is known as yet, that he would rather I have the embolization done, even though the first two urologists said not to. The first urologist I saw years ago said the pain is from the two epididymal cysts that I have, but he said he didn't want to remove them, or remove the epididymist as this can also make the pain worst. The radiologist I saw a few weeks ago who did say he would perform the embolization, he said the varicoceles are small, but the fact they are there, and my symtoms are symptomatic of varicosele, so he reckons this IS the cause to my pain, but I have my doubts. Has anyone read that web page called 'Against varicocele embolization' its where other guys have had the procedure done using coils and they have been left in worst pain 24/7?

Yeah I've read this, which is why I'm exploring the alternative method Howard has spoken of - this method elects not to use the coils.

Have you decided against the radio frequency pulse block?

Also, in a previous post I mentioned that I tested the water by having acupuncture on my right buttock area. I was told it would increase the blood flow around that area, including the groin.

During the procedure I had immediate pain and heat in my groin which traversed into my right testicle. Importantly, I had pain relief for up-to seven hours.

I believe this potentially points to a blood flow issue relating to the varicocele.

It might be worth trying this route first, it would certainly give you some indication.

Hi, I'm still deciding, I really don't know what to do. 😦 The pain specialist who is the one who would perform the radio frequency pulse block said I can just phone his secretary and book the appointment when I have decided. He said to have the varicocele embolization done first and see if it works, but he also said that he see's guys that have had the varicoceles done which hasn't worked, so they get sent to him for help... Reading between the lines I got the impression he doesn't rate the varicocele procedure, but I am a little confused as to why he said try it first before the radio frequency pulse block. I'm beginning to lean towards the cord denervation procedure instead, as Howard has suggested, seems the only real fix, but still no guarantee. The only problem I have with the cord denervation is with my urologist, he doesn't recommend it, he has basically said that he wont do it. 😦 I just cannot believe medical science haven't found a proper cure for chronic testicular pain, we are just left to suffer, or end up suffering worst pain because whatever procedure has made things worst. Does anyone know how Michael is doing, is he still pain free after his cord denervation op?

Hi Jim, I was also meant to say, yes I agree with the increase in blood flow makes the pain worst, so this really would indicate the varicoceles are the problem... I had a CT scan some weeks ago, I had contrasts dye injected in me by a machine, you can feel the contrast go through your whole body, and by the end of the procedure I had the worst pain ever in both testicles, both legs and down into both feet. We reckon the increased pressure through my veins put stress on the varicoceles, which obviously made them swell and caused the pain, but it was both sides at the same time. Then 3 days later I had another ultrasound scan and this is when they saw a 3.1mm sized varicocele, before this it was only 2.0mm, but its on the left side, I always have the worst pain on my right side, same side which has the two cysts.

Hi We5t, I'm in exactly the same position. My urologist is pushing for the embolisation, but I have reservations based on the issue with the coils. I'm waiting for my third ultrasound appointment, which is on Nov 14th. The urologist wants to confirm for definite if there is a varicocele(s). An NHS ultrasound in May reported of varicocele (I'm unsure of the grade), however a private ultrasound scan reported no evidence of varicocele.

My current urologist wants to also check my lower back, this backs up my GP, who is keen to send me for an MRI of my lower back. I have been plagued with lower back problems since my early 20's, so I'm now concerned this could be spinal.

Hi Jon55953, That is exactly my symptoms, a small hard cyst at top of the epididymis, and when I press on it or when my jeans/trousers press/rub against it, it hurts like hell. Have you done anything about the cyst jon55953?