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Hernia after Vasectomy - is this possible? Dr. Towfigh, can you please answer?

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  • Hernia after Vasectomy - is this possible? Dr. Towfigh, can you please answer?

    I am writing on behalf of my husband.

    My husband got a vasectomy at the end of September and has had nothing but issues since, specifically a lot of groin pain issues.

    Because of his pain, we've seen many doctors. He has had a few doctors tell him he has a hernia (although an ultrasound came back negative).

    His symptoms are as follows: He does not have testicular/scrotal issues. His pain is all in his inguinal area, specifically to the left and slightly higher than the base of his penis.

    If this area is pushed, he feels a deep ache that is painful. There also seems to be a bulge there (or softness). He can feel it, although I've tried to feel it and can't. He has pain in this area if he is on his feet all day (he works in construction), he gets pain when he lifts anything heavy (feels it deep in the groin) and this pain will continue to ache after he lifts heavy things for a while, he also has pain when bending over and if he sits forward and puts pressure on his stomach.

    Because he is in construction, it does not surprise me he does have a hernia but I find it very coincidental that he never had any pain or issues with his groin pre-vasectomy. I've looked into a lot of information about genito-femoral (also ilioinguinal)l nerve damage, and that this nerve damage can occur from a vasectomy because of the genital branch descending into the scrotum. I've also looked into referred pain, that this pain could originate from the genitals and refer to the groin. Further, some symptoms of genito-femoral neuralgia is pain during bending, sitting and lifting. Obviously these symptoms mirror hernia pain as well. With referred pain, if it is testicular/scrotal, would he not feel something in that area or can it literally refer only to the groin with no other symptoms? I know this type of nerve damage can occur after inguinal hernia repair surgery so I thought this is information you may be able to answer.

    I'm also wondering if hernia pain can continually ache or hurt for a prolonged time period after heavy lifting. For example, my husband shoveled snow yesterday, he could feel the pain upon lifting the shovel and the ache continued through last night. He does not have pain while sleeping at all.

    Can hernia pain can occur during sitting. I've read that "prolonged sitting" can cause aches/pains but he will get the pain as soon as he sits in certain types of seating. Like stated, this is not in his seat or his genitals but in his groin. The pain all radiates from the same area.

    I'm concerned that he is moving forward with the hernia diagnosis but that his issues may be referred pain and not from a hernia but instead from the vasectomy. I don't know if there was nerve damage during the vasectomy, if the spermatic cord/vas was pulled to hard and it caused issues in the inguinal canal.

    I appreciate your time in responding.

  • #2
    Look into the Genital Branch nerve. If ultrasound came back negative don't worry about a hernia. A lot of men have trouble with the Genital branch after a vasectomy. Best of luck to you!

    Comment


    • #3
      Originally posted by WorriedWife1 View Post
      I'm concerned that he is moving forward with the hernia diagnosis
      If he got the vasectomy so that you two could have a better sex life, then you should be very concerned about today's hernia repair method of choice. Laparoscopic implantation of large pieces of mesh can impact the penis and surrounding body parts. It did mine. The more active I was the worse it got. And it wasn't the type that a pill can fix. So, your husband's physical type of work is going to make these problems worse if he has them. He won't be able to stop sports or working out and just spend more time at a desk so that he can have his penis back. The inflammation affects all surrounding tissues, and gets worse with movement. It's not a problem that most men will talk about, but if it doesn't work there's no point in not talking about it.

      The big risk for both of you right now is that the majority of surgeons out there who do laparoscopic mesh implantation will seem very confident in the materials and method. You will feel very comfortable that he or she is going to fix him. You'll feel relieved once you choose a doctor to do the work.

      If you go for a consultation the surgeon will probably discount stories of dysfunction or chronic pain as internet rumors, or from the past. They might cite research work that supports what they plan to do, but not the research that describes up to 20% chronic pain. They might have hundreds of surgeries under their belt. Mine had over 400, I believe, so the advice to look for an experienced surgeon does not guarantee success if you find one. I had my surgery in 2014, and they still do things the same way.

      Watch this video and you'll see the guidance to place large pieces of mesh, even on the side that is asymptomatic. Sponsored by a medical device maker. Click anyway, even though it's intended for the professionals.

      http://www.ethiconinstitute.com/node/885/asset

      If he does decide to have surgery, find a surgeon who can say that they know their past patients are doing well, years later. "I don't know, I haven't heard anything bad" is reason to keep searching. Find a friend or colleague who has had successful surgery, and does what your husband plans to do, and get the exact same surgery. Make sure that your surgeon knows that their method and material choice work in the long-term, and that recurrence alone is not their criterion for success.

      Good luck. Be careful. The news these days is full of stories about the big corporations of the medical industry pushing sales over patient welfare. Opioids, birth control, trans-vaginal mesh, and hernia mesh among them. Even the physicians are trapped in the mess. It's up to the patient to find somebody that they can really trust.

      Comment


      • #4
        I had a variocele surgery where they also have to manipulate the spermatic cord and 3 days after surgery developed a inguinal hernia. My theory is that there was probably some weakeness there or maybe a asymptomatic small hernia that the area was made weaker due to the cuttin into the groin. So it's certainly possible that the surgery caused oa hernia or exasperated a condition that was not noticeable or symptomatic

        Comment


        • #5
          If there is concern for a hernia and there's no obvious bulge then a CT scan of his abdomen is reasonable (while doing a valsalva maneuver).

          this is pretty good at evaluation for a hernia.

          If thats negative he should
          follow back up with the urologist for a formal reveal.

          Comment


          • #6
            He has been to Shouldice in Toronto and he does have a hernia. It’s just not a “big” one. He’s also been to a post vasectomy pain urologist and he identified a hernia as well. I’m more concerned that the pain he is experiencing isn’t related to the hernia and is from the vasectomy.

            I’m really just wanting my specific questions answers in regards to his symptoms and whether they are indicative of a hernia (ache while sitting, pain lifting, etc).


            Thank you for your responses.

            Comment


            • #7
              From a patients perspective it sure sounds like symptoms of a hernia. I had a lot of discomfort when sitting. It seems the logical step would be to repair the hernia while its small especially if you do a non mesh, pure tissue repair Bc you can have better outcome when the hernia is small.
              i think it is awesome that you visited the shouldice hospital they are the best when it comes to a non mesh repair.
              after recovery from the hernia repair you could see if his pain is gone. If not it is something else. But at least he would of had his hernia repaired

              Comment


              • #8
                Jnomesh, did you start having symptoms right after your variocele surgery? What type of pain did you have while sitting? Your plan is identical to mine. This is the first step. Thanks for your response.

                Comment


                • #9
                  For me I felt a tear like feeling a few days after my surgery and was confusing Bc I never had surgery before so I didn't know if what I was feeling was part of the healing from surgery or something else. When I went back to thebsirgeon he said everything was healing well so I just gave it time. After a month I got a cat scan and it showed a large hernia. I had a burning feeling when sitting.
                  don't know where you reside but there are a few surgeons in the states that do non mesh repairs.
                  there is dr. Robert Tomas in Florida who specializes in the Desarda repair. There is keven Peterson in Las Vegas who is anti mesh and specializes in pure tissue repair. There is dr. William brown in San Francisco who specializes in pure tissue repair. And there is a surgeon in Long Isaknd new you're at Stoney brook hospital who specializes in the shouldice repair and trained at the shouldice hospital in Toronto and has done more than 650 of these types of operations and his name is Dr. samer sbayi. Best of luck!

                  Comment


                  • #10
                    The hernia could be causing symptoms but I doubt it, hernias can be huge and still cause no symptoms. Urologists act like vasectomys are a simple procedure just like hernia surgeons act like hernia surgery is a walk in the park for a patient and that is not the truth.
                    Heres a little article I found.
                    Post vasectomy pain syndrome remains one of the more challenging urological problems to manage. This can be a frustrating process for both the patient and clinician as there is no well recognized diagnostic regimen or reliable effective treatment.Many of these patients will end up seeing physicians across many disciplines,further frustrating them. The etiology of post vasectomy pain syndrome is not clearly delineated. Postulations include damage to the scrotal and spermatic cord nerve structures via inflammatory effects of the immune system, back pressure effects in the obstructed vas and epididymis, vascular stasis, nerve impingement, or perineural fibrosis.

                    Comment


                    • #11
                      Vasectomy can cause this pain depending on where the vas was divided. If divide at the testicle (common) then its very unlikely this explains his pain.
                      A vasectomy performed near the testicles and mid groin would be nearly impossible to unroof or cause an inguinal hernia.
                      Hernia can cause the same pain.
                      Hernia and a post vasectomy patient could cause this pain.

                      Vasectomy can injury genital branch of GFN. If vasectomy is performed near the inguinal external ring it could affect the ilioinguinal and genital branch of GFN which can cause similar symptoms..
                      Inguinal hernias can cause compression of this nerve.

                      He should get a thorough physical exam.
                      He should get dermatome map testing of the groin.
                      He could get a cord block under ultrasound guidance. If this takes care of his pain one could consider resection of the genital nerve and vasa vasorum of the vas deferens during an open inguinal hernia repair.

                      He should see someone familiar with groin pain, mesh removal, etc before proceeding with a hernia repair. There is much that should be considered, discussed to develop appropriate expectations for everyone involved.

                      Comment


                      • #12
                        Dr Procter offers good advice.

                        Just out of curiosity, what did Shouldice tell your husband about his symptoms and the hernia they found?

                        Comment

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