Vasectomy - Another PVP Case !

Men's health
1

Just found this site. Glad I did.

Another PVP sufferer. Had my snip done in October 12, local GP practice but got a GP who was aquiring the 'skills' to take over the practice once the main GP retired.

Well, he made a mess, first half fine, second half painful. Bust a blood vessel to, so that was stitched up to the VAS.

Rested after, ended up with two large haematomas one each side and a wound that didn't heal for 4 weeks and needed antibiotics.

That all eventually cleared but was still in considerable pain, especially the 'messed up side'. Off to GP, then referred to Urology. Scheduled for an epididymectomy soon now.

Won't do both sides due to risks of losing a ball, so it's one at a time, and if it works, as it only has a 50% success, they will do the other.

Pain isn't great, I won't take meds for it, other than ibuprofen etc, but that doesn't do much. Offered the usual gabapentin etc which I've refused.

As others have said, I queried what would happen if I got PVP and how would we manage it. The GP at the time said 'your Urologist would sort that' - erm I don't have one. No mention of how common the pain is 5-10%.

Only when I saw the Consultants in Urology did they say how comon it was. It's a very difficult 'condition' to treat is all they have said.

Current choices. Wait - I've done that, now surgical removal of my epididymus, possible the less sore one two. High failure rate. If it doesn't work, then de-nervation may be a choice - that will leave your nether regions numb.

Friggin fabulous. Simple procedure that you don't really fancy, but 'pressure' dictates. Totally ruined our sex life. I get bad pain after, and it takes days and days to subside. Also the site of the burst blood vessel is extremely uncomfortable (between ball and penis) so the consultant will do some 'clearing out up there two.

Seriously hissed off by it - WHY DON'T THEY TELL PATIENTS ?

I've complained officially, general sorry and denial of PVP. Complained direct to the GP that did the Op - he now has the local contract. I've asked him to ensure he makes patients aware of the consequences.

Oh and it's pot luck if you get it. doesn't matter if you are fit or not. It's really affected me and my sport as a cyclist (ouch) and I can't stand beeing battered about down there - so stuff like go-karts, fair rides that are bumpy are a no no.

The epididymectomy is going to be nasty, as that's quite a recovery process. I asked about having both done, but they said if it went wrong I would lose both balls. Best do one at a time, then I'd have one at least they said. I said, I'd be happy if you took them both off !

Never again. Feel like I've freely mutilated myself - could have done a better job with two bricks.

2

How did the epidymectomy go?

Any relief from pain?

It's my last option that one as I'm keen to try a reversal first

3

Epididymectomy only partially helped. Consultant removed some of my vas from within my groin that was pulling badly. Now suffering from scar tissue pain in the left, whilst still having PVPS.

Both internal scarring from the removal of the epididymis (the scarring is like a bigger epi) and also the 4 cm incision on the bottom of my scrotum where my testicle is now anchored in place.

I won't be having the other done.

Looking to have the more painful testicle removed but consultant isn't convinced that will help.

Never again ! Totally screwed up now !

4

Hi there

I'm really sorry to hear about your experience. I hope things have improved for you since you this post.

My husband and I have five children together. He has two from a previous relationship. We are both certain that we are done (we were done at three, to be honest, but do not regret the last two at all. They are beautiful kids). Our youngest is almost seven weeks old and we are trying to work out what our options are for effective birth control. Everyone seems to be talking about the snip as if it is a simple procedure, but the more I read, the more I worry about the consequences. I mean, it would be great for me to not have to worry about getting pregnant. That would be seriously wonderful, but I wouldn't want that at the expense of my husband's health. Thank you for sharing your story. I am wondering... if you could go back in time, what would you have done differently, apart from not having the op, of course. How would you ensure no unwanted pregnancies?

Thanks in advance.

Lelina

5

It's a relatively simple procedure, and I was only pain free on one side. The other was excruciating.

What you aren't told about is the risks. 1 in 10 go on to get long term chronic pain and my Consultant Urologist says it's common and difficult to treat (basically they can't)

It's ruined our sex life as I'm in pain all the time, worse at night and excruciating in the morning.  I'm on prescription strength codiene so I can get sleep at night.

Unfortunately I've had very little inprovement - loads of scar tissue in the operated on testicle, and the incision scar is uncomfortably sore where the testicle is anchored to the scrotum.

90% go right, but a 10% risk is way too high for you not to be informed about it.  Femaile sterilisation has a lot of side effects to.

Stick with condoms if you don't want and hormonal contraception.

It's not worth the risk.  We both regret the decision.  I'm still going back and to to Urology and pain clinic.  I've given my GP who recommended the surgery a hard time, and I've complained to the NHS about the GP that did the operation. Just awaiting a reply that's taken nearly 4 months and countless chasing.

Really research it before you make the decision.  Both operations had me off work over a month each time - would your employer support you if you end up off work for a month after the snip. I booked a day and a half off as holiday. Expected to be back in work on the Monday, except it was an emergency GP appointment due to pain, then A&E the next day as it was so bad.  I even had to pay for an ultrasound to see if I still had a viable testicle as the pain was so severe.

Your GP will dump you if you get PVPS.  Only will the Urology Team be honest.

6

Hi Lelina

It is a simple procedure, less than 25 minutes.

You've read this thread so you'll also know whilst simple it is not exactly safe.

I'm still on heavy duty pain relief, morphine, and it does not touch the bulk of the pain, it simply takes the edge off. The drugs they give to attempt to ease symptoms can cause horrid side effects.

The NHS will tell you (if indeed they do at all) that the risk is 1 in 10 (10%) - however the risks range from 5% to 30% depending on whose figure set you use.

I currently have no sex life at all, so in one way the vasectomy was a success it has prevented conception! This is an area I struggle hugely to deal with.

We opted for the vasectomy as after 22 years of the pill of differing sorts my wifes body was showing the strains of it and the coil caused large amounts of tenderness and pain.

The only method of birth control I would suggest is condoms or if able to tolerate it then female based contraception..pills or injection or even the coil.

I would not recommend surgical based contraception. The risk of complications for female sterilisation are higher than the vasectomy.

I am now waiting for July when I get to see the consultant (it has taken 15 months of fighting to get that appointment as GP felt damage was done and pointless re referring) and can discuss / demand a reversal which offers me a 70% chance of cutting back on the pain. But then I also stand to make the problem worse as well as a reversal can also triger PVP and if you already have it then it can make it a lot worse.

So if I could do anyhting differently it would have been to have not had the vasectomy and instead used condoms.

Anywhere between 5% and 30% chance of hubby getting severe debilitating pain and within that a risk of losing your sex life...it just isn't worth it

7

Since Nov 2012 I've had over 6 months off work, employer put me on half pay and the meds bill was going sky high. I one point there were 5 items on a monthly script....thats a hell of a lot of money every month since the snip, although I've now got a pre paid certificate so that has really cut costs back.

GP surgery (mine) has been pretty good other than ensure there has been a huge delay in re referring me to hospital. The surgery where I had the snip didn't want to know and as you say dumped me.

The total in lost pay, lost hours and meeical costs has now pushed over the £4k mark. Thats a hell of a lot of money to lose!

Fionally got the referal to see consultant in July. Given he wrote a great supportive letter to my employer (NHS believe it or not) detailing odds etc I am really hopeful he will agree to reversal. But knowing the area I am in it could be upto 9 months past July when I actually get to have surgery.

Sods law! The pain was dying back but this past week has really picked up badly to the point I am back on the Oramorph today and it isn't working. Great start to two weeks annual leave and I'm supposed to be flying to Italy on Friday. Totally dreading it now.

So very sorry to read the Epididymectomy wasn't a total success :-( Are you still thinking of the orchiectomy?

Take care mate

8

I'm going to have a vasectomy later this year, so I do not speak from experience. Although I do sympathise with the bad experiences detailed above - those blokes are clearly going through hell, I feel I must share what I've learned when researching my own upcoming vasectomy.

On average the chances of suffering chronic pain post-vasectomy are indeed somewhere between 5-20%. But there are vasectomies and there are vasectomies. It would appear that the OP was operated on by a general practitioner who had little experience, and the vasectomy was done very crudely. This greatly increased the chances of long-term complications.

In my opinion GP's should not be allowed to perform vasectomies or if they do they should receive a lot more training AND warn patients of the chance of post-vasectomy pain syndrome (PVPS). They should also introduce the various methods of vasectomy with their benefits and drawbacks.

In contrast a specialist urologist who only does vasectomies is likely to be a lot more careful not to disturb blood vessels or nerves. I've chosen a urologist who uses the less invasive 'no scalpel' method, and does 'open-ended' vasectomies.

The most common cause of post-vasectomy pain syndrome is back pressure on the epididymus. When the vas deferens are cut and all ends sealed off, as sperm continues to be moved through the epididymus towards the blocked vas pressure builds up. This pressure is painful and sometimes leads to rupture of the epididymus. The solution is to leave the testicular side open so that sperm cells and fluids can flow out and be destroyed and reabsorbed by the body. The other end of the vas deferens must be well sealed to ensure sterility.

The open-ended vasectomy was invented in the 1970's and reduces the risk of PVPS by two thirds. It is ridiculous that decades later most GP's are still performing the crude slash, tug & chop method and sealing both ends. And men are led to believe it's a very simple procedure with no complications, they are not made aware of the different methods. Maybe because 90% of men don't have any complications and greatly enjoy the benefits, they recommend it to friends some of whom just go and get it done without a second thought, and are unlucky enough to be in the other 10%.

I never had such personal recommendations. I was just looking for male contraceptive options on the Internet and since I always research such decisions I quickly became aware of the risk of PVPS. I've decided to go ahead with my vasectomy because I believe that by carefully selecting the best and most experienced urologist I can find and making sure my vasectomy is 'no scalpel' and open-ended, I reduce the chances of PVPS to around 2%: a risk I'm willing to take for a worry-free sex life. 

9

Most vasectomies in the US are performed by Urologists...they have a hgher incidence rate than the UK, although allowing for mormalisation of incidence to population to procedure it might work out even.

You obviously have the luxury of being able to travel around the country and pay for it privately, the majority do not. Instead they get the option of 3-4 venues within the NHS and if choosing a hospital instead og GP you will not always get the urologist performing the procedure but an underling (they all have to practice somewhere and as they are beyond student grade you won't be asked if a student can be present / perform the procedure) - so yes I fully agree if you can find the best urologist privately and avoid NHS Hospitals (especially teaching ones) then your risks probably reduce with the skillset you are paying for privately. Within the NHS you can't reduce the odds.

Even then though if you read the blurb of private clinics they still quote the same risk set, not because they have little faith in their own skills, but because as no-one has fully understands what causes PVP (there have been many many theories) they simply can't ensure you don't get it and they are fully aware of this which is why they still have to highlight the risks.

I think you are being a tad naive and mayhap simplistic with you thinking you've got the odds down to 2% when the official figures in the UK begin at 5%.

Even a 2% risk of losing my sex life would be 2% too much.

However I do wish you all the very best though and hope it goes brilliantly for you.

10

Thanks, yes I do agree that chronic pain is to be avoided at all costs, and I cannot fully empathise until I've been there myself.

Urologist stating risk of PVPS as <0.1% but my conservative estimate is ~2% based on several factors:

Start with the worst stats for vasectomy in general: 33% chronic discomfort and 15% chronic pain (look up study by McMahon, Buckley, Taylor, Lloyd, Deane, Kirk 1992). 

Reduce the risk by two thirds with the open-ended technique (Moss 1992) to 5% for chronic pain and 11% discomfort. 

Further reduce the risk to 2% pain 4% discomfort with the 'no scalpel' low impact method performed by an experienced urologist - this is just my estimate with no stats to back it up, only some studies stating that chance of ongoing pain is significantly reduced (eg Skriver, Skovsgaard, Miskowiak 1997).

So for all vasectomies there may be up to a 15% risk of PVPS but I can greatly reduce this to 2% by selecting the right urologist and procedure.

The best one I can find charges £380 for consultation, vasectomy and later semen analyses. Even though I'm in the lowest income bracket I think it's well worth saving up the money for this - who wants to hire the cheapest when it comes to messing with the crown jewels? Having said that if I push a few papers around and wait longer I can get referred to this same urologist by my GP on the NHS.

It is ridiculous that men are not made more aware of the risks and different methods so that they can make an informed decision about whether they accept the risks that come with a vasectomy. I would not accept the risks of a standard vasectomy but I am willing to accept the much smaller risks of a no scalpel, open-ended vasectomy performed by an experienced specialist.

11

Good luck.  My Urologist says PVPS is common and they do warn blokes at the Hospital.  The GP's are in it for the money, so don't tell you.  I've made it my goal to get my GP and the GP who did my operation to ensure they tell people - I've taken it as far as a official complaint, and it's now in the hands of solicitors. 

1 in 10 is way too common.

12

It gets worse.

now have low testosterone, right at the bottom of Normal. This is a range for all men of verging degrees of health and all ages. I am equivalent to a diseased 90 year old bloke.

must be all the scar tissue causing blood flow and operational ability of my balls. Docs said its within normal, showed him some research which aus I should be double the reading.   Going to have a hard battle to see an Endo and get replacement therapy.

what a nightmare

13

Bloody hell Ouchy cry I missed this reply of yours.

Yet again the hidden risk (well to the patient anyway) strikes again.

Did you get in to see Endo / get movement on replacement therapy? Really hope so mate.

They've agreed to a reversal for me....only taken 18 months to get them to do that. One more hurdle to clear and that is the consultant urologist tomorrow.

as you say what a nightmare, but a nightmare we didn't chose and something that was forced on us by denying us the ability to make informed decsions and give informed consent.

14

Still awaiting an appointment. Its an afternoon one so they wont take blood as it has to be done before 9am when T is highest.  So will have a longer wait.

Pain in scar tissue now coming back and PVPS in both is still there.

Im an athletic bloke and am struggling in afternoons and evenings. I refuse to drive distances in the evening as I am falling asleep. 

As a kick in the goolies I am starting to get ED issues. Not maintaining a hard errection and not getting night and morning errections very often.

This sucks. If I get HRT (and its a big if) my balls will shut down so I might as well get them cut off. I might get less pain.

Don't get the snip.

15

More blood tests show I am now way below the low level for Testosterone. GP still won't prescribe hormone replacement until it is authorised by a Consultant.  

So I have basically had the equivalent of castration and my GP still drags their feet. Thanks.

Anyone thinking of this op, bear in mind that 10 percent get long term pain, and some unfortunate sods lose testosterone production which will mean you could end up very poorly and with a floppy willy.  

16

sad Keep your chin up mate. I really hope you get some much needed relief and good news soon.

They've agreed to do reversal as 1st step for me....the battle for funding is raging in the back ground. I had a week free, well ok a week of minimal/no pain for a whole week smile sadly thought i came back with a vengeance today

17

Has the consultant authorised the meds yet? Hope so.

18

Had to move GP. New GP prescribed Testogel. Emailed Endo with latest results (down to 6.4) and he recommended replacement as well.

Still feel like crap. Most likely not enough as likely to need 2 sachets a day.

Pain clinic is now out of pain relief ideas so unless pain improves by spring next year I might as well get them chopped off as they are redundant.

Don't do it boys.

19

Most men, who if they`d known the problems with vasectomies would have opted for condoms. I certainly would, the condom method is almost as reliable as you make it,if you are not careful they will not be anywere near as reliable for you.

I had twenty odd years with 100% reliability but then was "sold" a vasectomy by a leading family planning charity. They sold the snip with very high pressure sales techniques and made it sound so simple and safe.

When the op went wrong I was "the only patient that had complained" and was told they could`nt help me.

20

I can't carry on much longer. Off to get gabapentin (which I have refused point blank) and anti depressants from the GP. I can't carry on with this level of pain.

This op has destroyed me.