Has anyone had Microsurgical Denervation?

You should ask if you may have an enlarged prostate - a condition called BPH. This can be determined with a simple ultrasound.

Hey unfortunately i am suffering from chronic testicular pain too. For almost a year now. I did lots of checks, MR, ultrasound and everything seems fine. It is better now than it was one year ago but still very annoying.

I will think about a microsurgical denervation as a permanent solution since i am not into pain killer and other things of that kind.

Does somebody had it? what is your experience? Did it work? Are you happy? Do you feel numbness in that area?

regards to all and good luck

I haven't has the denervation procedure yet. Have you had a cord block test where they just inject some lydocaine plus bupivacaine into the spermatic cord as a test? Is your pain continuous or does it come and go? Also does it stay in the scrotal region or does it go into lower back and down your legs? Both sides?

both sides. it is continuous but the intensity is variable. it is stronger on the upper part of the scrotum on the base of the penis but i feel it in the legs and lower back too.

now i am waiting for a visit to discuss and see if there is a doctor in my region that could do this surgery.

Does it seem odd to anyone that most of us with testicular pain also have cysts? I thought there was a simple procedure to drain those things with a needle, since they just contain clogged sperm. I think mine might be inflamed because it is hard as a rock, and burns to the touch.

Hi jon55953, Yes it does seem odd, I get the worst pain on my right testicle each and everyday, the one that has two epididymal cysts, my left testicle rarely hurts. I can live with the heavy ache, but the pain is too much. My two cysts are also hard, it hurts like hell when I press on them at the top of the testicle.

How are you Howard, we've not heard from you for awhile, you must be feeling good???

I'm going back to my urologist to discuss a Microsurgical Varicocelectomy where the veins are tied off/cut. I understand some go in favour of cutting the ilioinguinal nerve as well???

I'm going to demand a Spermatic Cord Block, then MSCD if cord block works, I'm just going to request they cut everything as I cant stand this pain any longer, its killing me.

My testicles are killing me, they are ruining my life, I cant sit down, I cant stand for too long, I cant walk, all I can do is lay down. I cant work, I don't go out, I cant even put trousers or jeans on, what sort of life is this???

I am so sorry to hear about the pain you are enduring. You should NOT have to suffer like this.

I had a botox injection into my spermatic cord on April 1 and after 3 wees it worked really well and kept me pain free through Sept. Then it wore off which it does after 6 months. My pain came back bad but I took Percoset each day and it stopped my pain with no side effects until I could get a second botox injection which I did on Oct 7. After 2 weeks the pain went away again and I have been pain free since then.

My doctor specializes in MDSC but he said as long as the botox and the perocset work for me he is happy and so am I.

I hope you get your pain stopped. There is no reason in modern societies to suffer like this. Good luck.

Hello Pauline44734

I am sorry that you and your loved one are going through such a difficult time.

If they are having these suicidal thoughts then we strongly recommend they speak to someone who may be able to help. The Samaritans offer a safe space where they can talk openly about what they are going through. They can help them explore their options, understand their problems better, or just be there to listen.

Their contact details are on our patient information leaflet here: https://patient.info/health/dealing-with-suicidal-thoughts, which also offers lots of other advice on how they can access the help they may need.

If they are having such thoughts then please do try to persuade them to reach out to the team at the Samaritans (or the other people detailed in our leaflet) who will understand what they're going through and will be able to help.

They can, of course, also speak to their GP. Alternatively, if your GP can help you with support for yourself and advice on how to help them get the help they need.

Please have a look at this page https://www.befrienders.org/directory

Yours sincerely,

Patient

Thank you .He is having counselling but that doesn't ease the physical pain .He has rung the Samaritans and I hae been prescribed anti depressants .We are doing our best to be positive but he has been absent from school since April and I am off work too to care for him ..I was encouraged to find this forum however the pain management consultant is dismissive to my suggestions that he try the spermatic cord block .

Pauline I also live in the NE, just outside of Newcastle. Hope you don't mind me reaching out, but if you both want to talk to someone also going through this, I would more than happy to help. I'm exploring lots of options re procedures and medical advice, also which might involve travel.

Here to help if need be - feel free to private message me if you'd prefer. Jeremy

Thanks so much. That would be good . My son was referred to Mr McEleny at Centre for Life Newcastle who offered to do the devervation operation but was put off doing this by the pain management team largely due to risks and his age .He might be able to help you .He didnt offer any other solutions except that surgery .At that time I didnt know about the spermatic cord block and now he doesnt want to meet again just says he is discharged now .

interestingly I've seen that urologist, in fact he was the same urologist who said loss of testicle may be a risk with MSCD.

It wasn't even offered to me as an option, I had to ask whether they offered MSCD. I got the distinct impression it wasn't even something they offered. I believe I queried this at the end if August and would therefore be alarmed if they've not given me best advice.

Can I confirm if this his first name is Kevin?

Yes its Kevin .We were referred to him after seeing a pediatric urologist who suggested that procedure .He seemed fine with doing the operation until the pain consultant advised against it .He wont even see us now to discuss why just says we are discharged now .He does the op privately at the Nuffield in Jesmond though .

Thanks Pauline.

May I ask when he said he could perform this?

I ask because I inquired about this in last August this year and was informed it wasn't an option as I risked losing a testicle. At the time Kevin told me I had nerve damage and that management was the only option. I was offered pain management and a referral to a Nuffield based consultant, which I agreed to but at the time but I've since cancelled.

I'm perplexed why he was offering this but then reneged and now is refusing to see you.

Like you, I too when with the private route initially, although I stress I only did this because one of the local GP's in the practice I was previously with, one didn't react quick enough to treating an infection I had in January and two made a mess of an Urology NHS appointment, requesting a 'routine' and not 'emergency' appointment.

At the time of your last SoL appointment with Kevin, did you ask the reason the pain management specialist had with Kevin performing the MSCD procedure?

It would be handy to have a reason to attribute this to the 'risk' complications they fear are involved with this procedure.

I suspect they fear the risks are partial or total loss of sensation in the genital area.

Hi Pauline, So sorry to hear about your son being in so much pain, especially at such a young age. Is his pain located in just one or both testicles, does he suffer referred pain down his legs at all? Did his ultrasound scan show any abnormalities such as varicoceles or cysts? You are right is pushing for a second opinion, don't give up, keep pushing for answers. Ask your pain management team about the Ultrasound-guided pulsed radiofrequency ablation procedure (non invasive) this is what my pain management team have just offered me. They gave me the ilioinguinal nerve block back in the summer, and now they have offered the same block, but with a radiofrequency probe which heats up the nerve, its not meant to be a permanent fix, but its meant to help. I will most probably try it, but I'm currently waiting to speak with my radiologist again about the varicocele procedure. Good luck and keep us informed.

I was meant to say, I also live in the UK, I live down south in Dorset.

My son was told he would be put on the waiting list for the MSCD op in July this year .He was to have a CT scan and MRI first and then see the pain team . Pain management consultant decided the op will not work as he didnt get relief from the nerve block .The pain team are most unhelpful dont return calls or emails .Luckily the GP is sympathetic .He had an ultra sound in April to see if he had epididymis orchitis which he did at the time they didnt mention and cysts etc .His pain is only in his testicles mainly left .He is in bed nearly all day in pain .

I have a feeling that they will do the operation privately but mot on NHS incase in goes wrong and hes left in more pain .

Hi Pauline, have you had word back to say that Mr McEleny will carry out the MSCD?

My appointment with Mr McEleny was in August, I surmise that in-between this period Mr McEleny has been warned away from carrying out the procedure.

There is a place in London carrying out MCSD - 'International Andrology London'.

Has anyone heard of this place?

He wrote on 24 Sept to say the pain management team have advised that surgery would not be a good approach for my son .I have emailed him to ask to meet to discuss why and he again wrote to say he has discharged him and referred him to a general pediatrician nothing to do with pain or urology just to get me to go away I suppose .

which medications do you take and do they help ?

I'm on nerve blockers (gabaptentin) which do work, but the drowsiness is terrible. Have you considered contacting International Andrology London?

I totally understand how your son feels, it must be awful for him. I wonder why he's not getting relief when laying down, so it cannot be varicoceles, it more likely epididymistis, has he been put on antibiotics, does he get relief then? Has he ever had a sports injury at all, playing football, hurt his groin area or even hurt his back at anytime? There seems to be so many different types of testicle pain, each person has similar/but different symptoms, its really crazy to learn the human body can cause this much distress, and with an impossibility to get a diagnoses. I was told the same thing when I had the nerve block done, my urologist said I have a less than 50% chance of it working because I didn't respond to the nerve block straightaway, it took 5 days before I felt the pain subside. My pain management doctor who performed the nerve block said it can take up to one week before the nerve block to work, so who is right, my urologist, or the pain surgeon guy?

Pauline, Your urologist may be hoping that your sons condition will go on its own, he is young and hopefully whatever is causing his pain will burn itself out.

His pain is less lying down .Walking is much more problematic .He had a torsion last year and so needed an operation and this problem startedthis year after he was kicked in the testicle.It is nerve pain .I think he needs a higher dose of gabapentin but as hes only 15 he may not get this .What dose are you taking ?

Hi Paulina, So was his operation to correct the torsion a success? Then a year later he got kicked in that area which caused pain, sounds like the trauma from being kicked has caused some damaged, hopefully this can repair itself overtime. Such a terrible thing to happen so soon after the operation. I myself stopped taking gabapentin, the side effects were terrible, I felt like a zombie. I have tried all the powerful medication over the years, non of them really work, they just add to the problem and made me feel even worst. The only medication that helps a little is Tramadol, its just a strong pain killer, its meant to be addictive, but I don't smoke or drink alcohol, so I doubt I will become addicted to it, I haven't yet. I only take one now and again, as I'm somewhat against medication, so I just live with the pain and cope the best I can.

Hi Guys, I really need some advice. I’ve just had my varicocele embolization appointment through, its booked for one week before Christmas. Originally I was glad to be referred for this procedure to be done, as I’ve suffered from Testicle pain for 14 years now, but I've just given the radiologist department a call to double check if they use coils or not, and yes they use coils. They sent me a fact sheet, this is what it says...(Copy & Paste)

”The procedure is performed in a surgical area in sterile conditions.

The radiologist will give you an injection of local anaesthetic in the groin and, once the area is numb, will insert a needle into a large vein.

A wire followed by a soft narrow tube called a catheter is then inserted.

When the catheter is in the correct position, a clear liquid which makes the area visible is injected into the catheter.

When the radiologist is satisfied he is in the correct position, coils and special liquid are used to stop the blood flow.

The procedure should take between 30 minutes and an hour’….

So what do you all think?

If your pain is symptomatic of varicocele pain then I see no reason not to go for it. Obviously the procedure of using coils is the gamble and there's a chance I'll be facing the same gamble following my US next week. There doesn't seem to be any UK based clinic offering embolisation using the non-coil method. To be honest, there actually doesn't appear to be recent literature documenting the alternative method using transcatheter polidocanol foam sclerotherapy without coils.

Do you have the option to have the coils removed if the need be? Also, do you have the option of MSCD if the need be?

Have you looked at this place in the UK offering MSCD?

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Hi Mr Jim, I cant read your last reply, seems its been moderated for some reason.

Jim Its very odd .What was the name of the consultant at the Nuffield ? If its nerve damage then surely that is what the MDSC op is for .Thats the same situation my son had offered the op and when he was sure it was nothing other than nerve damage refused it .Maybe an operation has gone wrong .He told my husband that he was the only NHS consultant in the country that did this operation .I am going to make a complaint about the pain management team and ask to see someone else .I think maybe incorrectlly that the consulant doesnt like me as i have expressed my feelings and isnt helping my son .Can you tell me which medication you take Jim ?

International Andrology London.

Check out their website.

Pauline I have mentioned before I take gabapentin, however I do not recommend this medicine.

I also believe hands are tied re the MSCD, consultants likely want to perform the op, however higher powers are stopping them.

sorry I meant to ask how much gabapentinyou take . I think you are right about the operation .Also can you remember the name of the consultant at the Nuffield that Mr McEleny recommended ?

You would be better sourcing advice about dosage from a medical professional. 😃

In regards to who Mr McEleny recommended at the Nuffield, I saw Mr McEleny at the Nuffield. He determined nerve damage following my potentionally epididymitis. As I've mentioned, there was a gap between going to the Nuffield and the start of the my issues. I was wrongly diagnosed by GP's in a previous medical practice, they believed I had a pulled muscle in my side and I unfortunately believed them.

As far as I'm concerned ever Mr McEleny did was great, especially based on going to him so long after my problems had started.

It's a great shame they can no longer provide the MSCD, but like I say it will be out of his hands.

Hi Jim, I will have to ask if the coils can be removed, I'm really not sure about the embolization procedure, destroying these two large drainage veins cant be healthy for the body, I've read so many horror stories. In some cases the MSCD procedure seems less risky, an invasive operation, but less invasive side effects. Yes, my urologist at Southampton hospital performs the MSCD procedure, he is meant to be the best in the UK. He has said not enough is known about the procedure, that he's had some successful cases, and some unsuccessful cases. He wanted me to have the embolization done as its a less invasive procedure, but I may ask him that I have the MSCD done instead, its a really hard decision to make, there is no guarantee he will agree anyway. One consultant I saw last year said my pain could be caused from the pelvic floor, in some cases I can agree with this, as the symptoms also match. I just wish someone knew what the problem was, instead of throwing ideas around. These doctors are good at telling us what its not, but they cant tell us what it is... 😦

Hi Paulina, So was his operation to correct the torsion a success? Then a year later he got kicked in that area which then caused pain again ?

We5t I've sent you a personal message on here. 😃

Hi Jim, I've replied.

Yes .Hes back in hospital with severe pain .The pain management team have suggested increasing gabapentin and introducing duloxetine which hes had before.Its seems like its that or nothing .They wouldn't discuss another nerve pain block .

Hi Pauline, Ask your sons pain management team about a Ultrasound-guided pulsed radiofrequency ablation, its another ilioinguinal nerve block but using a radiofrequency probe at the same time. I'm in the UK and this is what my pain management team have offered me, I will most probably have it done if I dont hear anything else about the MSCD procedure.

My varicocele embolisation has been brought forward to next week, but I'm not sure if I should have it done, as I've read so many horror stories regarding the use of platinum coils.

I will thank you however they do not reply to any of my emails or calls .

Well I chickened out, I postponed the varicocele embolization procedure.

The radiologist even phoned me yesterday evening to discuss the risks, what a lovely man he is.

He said that he has never had a patient come back with worst pain after the procedure, he said the only real side effect that he is aware of is the coils may cause inflammation, but this normally disappears over time with use of anti-inflammatory medication.

He said we do this procedure all the time and its a success, he done his best to reassure me, but still I couldn’t help think that having metal coils left in the gonadal veins was a good idea, so I cancelled the appointment.

In the meantime I’m still in pain with my testicles, I cant help but think that today could have been a success, that I could have got my life back if I went ahead.

I was just curious We5t. In a previous post about a month ago you mentioned pressing on the head of your epidydimis, and you said you thought something popped like a cyst or something, but then afterwords you got relief from your pain. So was that only temporary?

Hi jon55953, Yes it was shorted lived, pain came back on the forth day. I really thought I had a breakthrough, that the cysts were the problem, but I was wrong. I can still feel the two cysts on top of the epididymis, and this is where the pain is extremely sensitive, its a trigger point which seems to bring on the pain instantly.

That is exactly the same place where my own pain comes from. My doctor injected the botox right into that location 4 wees ago. It hurt terribly for 2 weeks after that but now I am pain free. You should find a doctor who will do the same for you.

Hi jon55953, Its been two months now since I thought I had a breakthrough, these two epididymal cysts I have are killing me. If I press on them, or when my jeans/trousers press or rub against this area, I get pain instantly. Surely the best option in cases like this is to have the cysts, or even the epididymis removed?

Hi pauline. Hope you and your son are well. I was reading your previous messages in this group. Seems like your son has been experiencing load of testicular pain for a long time. I have been suffering it too due to a left varicocele.

I had an embolization with coil through NHS at Freeman Hospital and I truly regretted it. After that, I started experiencing more pain in the left testicle, left kidney, constipation, dull achy pain. I saw many urologist, including Kevin Mc Eleny and he did not help me whatsoever.

I finally found a lovely urologist who was able to remove these coils from my body and sort the varicocele through laparoscopic approach, this happened at kings college, on a private regime.

After the embolization, and the laparoscopic surgery I still experience some pain and tenderness in the left testicle. I have just been today to my GP to get referred again to the Urology at Freeman Hospital.

Feel free to contact me here, even privately.

P.S. I live in the North East too, precisely Newcastle Upon Tyne 😃