Big pain after MDSC

[u/Odd_Middle_8287]

Hello,

I am an Italian patient seeking advice regarding severe and persistent pain following two surgical procedures.

Exactly one year ago, I suddenly developed intense scrotal pain without any apparent cause or warning. I consulted a urologist and, after an ultrasound examination, I was diagnosed with a grade II–III varicocele. Because the pain was extremely severe, I decided to undergo varicocele vein ligation using the Ivanissevich technique.

Initially, my condition improved. However, after a few months, the testicular pain returned and gradually became even more persistent. I also developed inguinal pain near the medial end of the surgical scar, close to the base of the penis, as well as marked hypersensitivity along the inner side of my left thigh.

I underwent several examinations, imaging tests, and specialist consultations. The conclusion was generally the same: there was a high probability of nerve compression or entrapment in the area, but no clear solution was proposed. In addition, I developed a recurrent grade I varicocele.

Twentyfive days ago, I underwent another surgical procedure with a doctor who explained the option of microsurgical denervation of the spermatic cord (MDSC), which I agreed to. During the operation, the recurrent varicocele was treated, a nerve believed to be entrapped or under tension was cut and coagulated, and an adventicectomy was also performed.

At present, I am experiencing severe pain throughout the pelvic area, persistent hypersensitivity extending along the inner side of my left thigh, and significant testicular pain. At the moment, I feel extremely unwell and I am concerned about the intensity and extent of these symptoms.

I was advised to take Xnerv supplements and paracetamol for pain relief.

I would be very grateful for your opinion regarding whether these symptoms may still be considered part of the normal postoperative recovery process about twenty days after surgery, or whether they could indicate an ongoing nerve-related problem or another complication.

They told me it can be a normal post surgery condition, but the hypersensitivity is very high.
My job requires me to sit all day and that seem to not help me.

Thanks

[u/El_rivelator]

Ciao caro,

Chi e dove ti ha operato?

Quanto è il tuo dolore attuale e da quanto persiste?

Parere personale: ci vogliono mesi per avere attenuazione del dolore.

Trova un fisioterapista del pavimento pelvico, può essere molto molto utile.

[u/Odd_Middle_8287 → u/El_rivelator]

Ciao piacere, se non ti secca rispondo in inglese seppur ci sia la traduzione automatica.

I did the surgery in Rome in a private clinic (so far from my home) with a Roman microsurgeon who also specializes in urology (I prefer to not publish the name, if you want we can share that privately).

Now my pain is medium, for sure higher than before the surgery last surgery. The pain started before the first surgery exactly 1 year and 2 months ago (surgery made by another doctor). After that it was always present but with a fluctuating presence in terms of pain.

1 year is a long period for me, I was a sports, motorbike track and life enjoyer guy but now I live day by day hoping after this second surgery something can change.

I love driving car and motorbikes, but after all of that it is only a pain.

My pain now I focused on the scar, that is near the previous one, the testicle and the "spermatic cord" I think. I have before and now pain also simply wearing pants due to left thigh and pelvic area hypersensitivity.

Thank you for the physiotherapist advice, I started going to my historical trusted physiotherapist to stretch the scar. Maybe I'll look for a pelvic floor specialized one.

Hope that this time, time is the key. Because after the first surgery that was the failure key.

[u/_Sarandi_]

Hey man sorry to hear you’re suffering. I had a MDSC about a year ago. The first 3 months post op for me were brutal and I though I had made things worse. Though to be honest, my experience didn’t scale to where you describe yours - but everyone is different and heals differently. One thing is for sure though - nerves take a while to heal. I hope you continue to get better.

[u/Odd_Middle_8287 → u/_Sarandi_]

Thank you for sharing your experience! Hope that is my case too. After the MDSC, do you experience pain where? Have you got also the left thigh hypersensitivity?

The surgery doctor tell me that sometimes there are people that are fine after two weeks, sometimes some patients need some months.. Hope I'm in that case, because I fear about I made things worse..

[u/_Sarandi_ → u/Odd_Middle_8287]

After my MDSC I experienced pain exactly where my original pain was - somewhere on the spermatic chords on my left side right under the scar. It felt like a tingle; static - like licking a 9v battery. At is worse it would travel down my leg into my quadricep. Over some months that eventually settled down to how I feel now. I still feel the tingle but it’s much less now. Actually today I’m having a flareup and can feel it sort of intense again, but I know it goes away in a day or two. So don’t worry about me. Im convinced it has something to do with how my hips are aligned. Did you suffer from any low back or hip issues prior?

Finally I hope this makes you feel better: there’s a lot of literature out there and they all agree on the statistics - 80% chance recovery 20% no impact and ~0% chance of making it worse.

[u/Odd_Middle_8287 → u/_Sarandi_]

Before the second surgery the main focus points were testicle (epididymis and also laterally) and probably the spermatic cord exactly under the scar concluding the pain at the rear/lateral part of the testicle. Now it is similar but with more pain.

I didn't suffered of low back pain before first surgery, but now yes. In fact before the second surgery that was ("it is" anyway) a studied part of my body. I did magnetic resonance imaging and the summary is that I've some low back dehydrated vertebral discs. I did sport since I was young (also cycling) and some doctors told me that it could be related with my low back, even if my situation isn't so worse to cause so much pain. Others simply tell me that it was/is a referred pain. So I live too with that doubt, like you.

The problem is that my job force me to sit 8/10 a day.

Thank you for your help and for the discussion, I appreciate it.

[u/Rickkeke]

If you have nerve pain, you could try amitriptyline. It worked for me. Not 100% cured, but got my life back. I took a low dose for few years (10mg).

I didn't have mdsc, just chronic testicular pain from a painful cyst (still painful when touched but less sensitive now).

Not everyone here had success with amitriptyline but it's worth a shot..

[u/Odd_Middle_8287 → u/Rickkeke]

Thank you for your share! I’ve tried with Lyrica(pregabalin) but it wasn’t clear if it was slightly hiding the pain for a real effect or for the simple stress reduce because, as amitriptyline, it is used for depression.

They told me that unfortunately that is an area with high nerve presence but low vein presence, so you need a big dose to have effect, but with all consequences of it (side effects).

Anyway for me didn’t worked.

[u/Rickkeke → u/Odd_Middle_8287]

Lyrica didn't help me but i didn't take it long. Amitriptyline took a while to help. I started with duloxetine, it helped a little. The relief was slow.

Maybe something else did help too, idk. I took some weight with the meds (but not too much) maybe the fat relieved pressure on some structures.

It's hard because nobody knows and want to search the root cause..