Has anyone had Microsurgical Denervation?

There are many different types of nerves that pass through the spermatic cord on the way to the spinal column where the signals end up in the brain as pain. The nerves originate throughout the entire scrotal region including the epididymis, testicles, scrotum, penis etc. Then there is also a sheath of nerves that enclose the spermatic cord too which often transmit pain.

So it depends on the doctor who performs the procedure how aggressive he wants to get in cutting nerve fibers. My doctor said he would be very aggressive with me and would cut most nerve fibers. But even in less aggressive cases some of the nerve bundles are cut. This is why the recovery from pain can take several months - those local regions around the cut ones are inflamed and still send pain signals to the brain until the whole region heals.

All - this thread has been very helpful information so thank you all for your time! I am scheduled for the MSDS procedure in June in Chicago with Dr Levine.

About a year ago I had a vasectomy and had a "hematoma" after the procedure where an artery bled significantly. I had scrotal swelling the size of a big orange and was black and blue bruised all down my legs for 6-8 weeks. I have had a lot of pain for the last year to the point where I have little quality of life and cant do anything active. I cant stand for more than 5 or 10 minutes at a time due to the scrotal and leg pain. I was left with a hard clot stuck to the left testicle the size of a lime initially and it is now marble sized after a year as it resorbs.

Like others on here, the pain radiates down my legs and Ive dealt with a lot of leg aches and pains along with the scrotal pain. I have also had bad back pain when I stand which can be unbearable at times. Im 34 and never had any pain or back issues before the vasectomy nightmare last year.

I saw Dr Levine 6 weeks ago and he performed a test chord block. My legs and left scrotal pain felt the best ive felt in a year for about 2 hours after the block! My back still hurt but my hope is that I can focus on my back if the MSDS procedure can fix my chronic scrotal pain and leg pain.

I wish you all the best with the procedure. Did you ask Dr. Levine about a Botox injection into the spermatic cord? I only ask this because I was also scheduled for a MDSC procedure a year ago but my urologist offered me Botox as an alternative. It has worked wonders for me with no side effects for 6 months, after which it has to be done again. It is done the same way as the cord block you had with Lidocaine and just takes 5 minutes. The theory is that if the pain receptors can be turned off and given a rest then when the botox wears off they may not turn back on.

Hi mate, I get pain in both testicles and both legs all the way down to my feet. My leg pain is 100% caused by whatever is going on in my testicles, I'm due to have a varicocelectomy.

Hi Howard

I have taken my son to a clinic in London twice now .He had a spermatic cord block the first time and he did get pain relief but it didn't start until about 48 hours later .Is this unusual ? The relief lasted for 24 hours .The doctor wasnt to make sure it wasn't a coincidence as he has good and bad days so we went again the following week and had the same result .I did ask him about the botox and he said he didn't use botox for spermatic cord blocks but said he could consider it .It was too late then to do it but I'm tempted to take him a 3rd time to try it .The arent doing surgery just now due to coronavirus.

It is not unusual to get pain relief from the cord block after a day or so. the reason is that the spermatic cord is a very large complex bundle of nerves and it is not always easy to find the nerves that are transmitting the pain. It is like a phone cable that carries hundreds of wires where only one or two are the problem.

The lidocaine takes a long time to diffuse away from the injection site until it accidently encounters the offending nerve fibers. My first botox injection took 3 weeks before I got pain relief that lasted 6 months. The next injection was right at the head of the epididymis where most of my pain was. Then the pain relief occurred after a few days and lasted 6 months.

Try to get the botox injection. Also was the cord block bipuvacaine plus lidocaine or just lidocaine?

It was just lidocaine . When the doctor rings today to talk to my son I will ask him if he can do the botox .He seems a lovely man he answers all my questions and makes us very at ease .

Yes - please press him on the Botox. I think it is really worth a try and has no downside. Botox usually takes a week or two to stop the pain because it is very thick and needs time to diffuse around the spermatic cord.

I asked him tonight when he called to see how my son was .He said that he would look at the research on this and if it was favourable he would do it .I'm so happy that we have found him after being beaten down for so long by the pain management team in the NHS I had lost hope .

That is wonderful!! I know 4 other men who had botox and they all responded well + plus me!!

Thank you Howard and all the other men for helping me and my boy xx

I have a video conference appointment with Dr Raheem tomorrow afternoon. 😃

Hi Pauline, I'm so glad you son had some pain relief, even though it was for a short time. Its not unusual for the nerve block to take sometime to work, my pain doctor told be it can take up to 7 days before I would start to feel any benefit from the illiongail nerve block, it was actually the 5th day before I started to feel relief, it only lasted four days. I know what you mean when you say about the NHS beating you down, I've had 14 years of the NHS beating me down, they treat you like its all in the head, like you are imagine the pain, its wrong that they are allowed to treat people like this. Has the London clinic offered to perform the MSCD procedure?

They have but aren't doing surgery now due to coronavirus. The doctor wants to try a course of shock wave in the meantime and he is looking at research in to using botox for the spermatic cord block .He will let me know tomorrow .

and please let us know too!

Hi Howard, How are you doing?

I'm finding my pain starts just by being stood in the bedroom putting on a pair of trousers. I'm only stood in one spot and as soon as I pull on the trousers the ache starts and then gets painful.

Its really strange as the seam of the trousers is not touching my testicles, there is room in the crotch area, so I really don't understand where the trigger point is.

I'm not even having to sit down for the pain to start any more, the ache starts within seconds of being stood in one place with the trousers being on, but if I quickly take them off the ache/pain then subsides.

What do you reckon?

It sure sounds like nerve pain to me. The movements you go through in putting on your pants probably rubs the offending nerves in some location. Is it repeatable that the pain gets worse every time you put on your pants but subsides when you remove them?

What are your plans now for any procedures?

I do ok. I am waiting for the doctor's offices to open here so I can schedule a botox injection but that is a long way off unfortunately. So I take one Percoset every 3 days and that helps a lot. This closing down of medical services is causing a lot of problems for many people not connected to the virus. Good luck.

Hi Howard, I'm still waiting for the varicocelectomy, the doctor's secretary said back in February that it would most probably be at the end of May/beginning of June, but now its been postponed until, I don't know??? I am noticing after every bowel movement that my right testicle, groin and right leg is aching and gets really painful, the testicle feels heavy and firm, its tender and hurts at the top (at the head of the epididymis). It just puzzles me why it gets so painful when I put a pair of trousers or jeans on, I cant feel or see that the trousers or jeans rub or press against my testicles, they seem to have room. I do have two pairs of jeans that I can wear that don't trigger the pain, they must be cut slightly different and not interfere with anything. The doc I saw did say that it sounds like a drainage problem, but how can blood clotting cause a pair of jeans to trigger the pain to start? I'm still not convinced those two epididymal cysts that I have are not the cause to all this pain, or unless I have two problems, the varicoceles and the cysts? I just wish this lockdown would end so I can get my varicocele operation done and dusted, I would have MSCD done tomorrow, or even a Orchiectomy. I strongly believe having the testicle removed along with the epididymis would solve my pain for sure. I'm glad your Botox and Percoset is working.

From the way you describe it it really sounds like a varicocele problem to me. The whole testicular region is filled with tons of nerves ( for obvious reasons!) so any changes in blood flow can trigger these nerves to send pain signals to the brain. The whole area gets so hypersensitive that the pain seems to radiate from everywhere so you cannot tell where it originates.

I think you are smart to get the varicocelectomy and hopefully soon. But just remember that it is a surgery and takes a few weeks for the pain to subside though I think you will be better in the long run compared to an Interventional Radiologist putting coils in though that procedure has a quick recovery.

Have you had a varicocelectomy Howard, did it work? I remember you saying you had the embolization procedure, but without the metal coils. I'm hoping the surgeon can cut some nerves while he's in there, I know its only a small incision, but I guess the veins must carry some nerves as well. I read somewhere that some surgeons decide the cut the ilioinguinal nerve while performing a varicocelectomy.

I believe they cut nerves higher up, they generally go into the groin.

So does that also make it a partial MSCD?

No I did not have a varicocelectomy but if I had to do it over that would be my first choice to see what happens. The procedure does not go anywhere near the spermatic cord where the MDSC procedure does its magic so I would not expect anything in that regard. But it will eliminate your varicoceles which hopefully will reduce your scrotal pain but just remember that it is a surgery with a recovery time of several weeks so the pain relief will not be evident for about a month. I know you made the right decision on this as a first step.

My pains are now starting to go into the tip of my penis when I'm walking. Ive recently started experiencing a sharp shooting pain after walking for about 10 minutes. It feels like something sharp is trying to force its way out of my penis.

I'm also experiencing a lot of lower back and side pain too. The pain is like claws being attached to my back.

Not pleasant, even the percocet doesn't mask it at times.

Sounds similar to kidney stones Jez.

I guess if veins have nerves, then cutting some of these veins can only be a good thing. The urologist surgeon said he would do the right side first, then I go back after six weeks to have the left side done.

Yeah, always been my theory too Wes.

I've been scanned more times and a tin of baked beans... They claim nothing can be seen.

So frustrating.

Howard

The London clinic will only consider doing the spermatic cord block with botox under general anaesthetic .I'm disappointed.Im sure you said it was a simple procedure .I feel like they have drawn us in and now are wanting to commit to expensive procedures .The shock wave treatment is very expensive too . I don't mind spending money to help my boy but feel like it's a con now .I've been working overtime to cover so I'm ok for now. The young man that contacted me who had MDSC in America had also been to this London clinic in the past .He is still in pain after his surgery and advises against it if possible.

It is very frustrating. I know what you are going through.

I don't understand the general anesthesia as I had none except some local freezing. for sure.

BUT having said that I would still get the Botox. When they say a general anesthesia they may just mean for 5 minutes like when you get a colonsocopy where they put you out for 5 minutes.

I would really try to get that done if you can and see how your son responds.

Tough times all around. I wouldn't read too much into their intentions. Also everyone responds differently so one person's experience may not be the same that your son will have.

Hang in there.

Howard

Pain in tip of penis is usually related to prostatitis.

thanks

Paul

Hi Paul, yep the doctor has put me on a course of co-amoxiclav.

I was actually really unwell last Friday, sickness and shivers with tiredness, the stabbing pains in my back were there, but they've been there since last year.

Hopefully that will clear it up then. Have you tried flomax? That should help if it is prostatitis and can also help with epidydimitis. It does have weird side effects though.

Cheers,

Paul

Yeah I've heard about the side effects, not it's not something I've requested. We'll see if the antibiotics clear it first, although I have my doubts.

Have you had your prostate checked Jez? Are you needing to pee more frequently (more so at night), problems starting or stopping?

No chap, no increased peeing.

BUT, I do get excruciating spasms on occasion between the top of my buttocks. This is very infrequent mind.

Hi Howard

I have an appointment in August for my son to have the botox injection .It is very expensive but I hope he will have the same relief as you did .Is there anything I should ask ?

Hello Pauline,

That is very good news. I know these botox injections are very expensive. Here in Canada it costs $450.00 plus we have to stay the night before at a local hotel. It should not be that way since we do not use it for cosmetic reasons.

The first time I had the injection it really really hurt for several days at the injection site. It felt like I was kicked in the groin. So the second time my doctor first injected some lidocaine into the site to numb it and that was good. You might ask about that.

Also the pain will likely persist for several weeks after the injection and then one day it is suddenly all better. The reason is that the botox is very thick so it takes to diffuse around the spermatic cord and hit all the nerve fibers that pass through. There are hundreds of nerve fibers but only a few are the ones that carry the pain signal to the brain. If your son is lucky the botox will hit the bad nerves early but in my case it took a few weeks and then suddenly the pain was gone for 6 months.

If it works you can redo it as many times as you wish as the body does not build up a tolerance.

When I first went for mine I was in so much pain that my doctor prescribed Percoset for me. It was like a miracle for me and really did save my life. Maybe you can ask this doctor about a prescription for your son until the botox kicks in. My third botox injection has been delayed now by 3 months because of the virus and if it were not for the percoset I could not survive. I only take one pill a day and it has no side effects.

Also try to keep a record of what triggers your son's pain. I finally narrowed it down to a few activities which I try to avoid when possible.

Good luck.

Howard

Hi Howard,

I notice you are located in Canada. I am as well (Toronto) and am wondering if you have any advice specific to the Canadian system and just starting the process (I understand all provincial systems differ). I have yet to see a urologist (misdiagnoses have led to 3.5 years with condition - hernia, bruised pelvis, torn labrum, FAI).

Any advice for someone starting out would be greatly appreciated. And thanks for all previous advice. I am just beginning to go through this thread and starting to feel hopeful again.

The pain is around the right testicle and radiates a little upwards to abdomen and further downwards to back of knee.

Thanks

Brian

Hi Brian,

I STRONGLY suggest that you ask your family doctor for a referral to Dr. Keith Jarvi at the Mount Sinai Hospital in Toronto. He is not only a urologist but he is Canada's top doctor for scrotal pain. I have seen him now for 2 years and he can assess your situation and provide the best solution for you. I had a Botox injection into the spermatic cord twice over a year and it helped a lot with the pain. Over the past year I just manage the pain with Percoset as needed. But he also performs the MDSC procedure which is a better long term solution. Good luck. Howard

P.S. OHIP will cover all expenses for this (except the Botox injection).

Thank you so much Howard. I will follow up with my GP. I have a meeting soon with Dr Whelan at St. Mike's (MRI conclusion was possible labrum tear and FAI so I was referred there) and hopefully he can help with the process.

Again, thanks.