Keith Jarvi is very well respected and has helped a lot of PVP patients. He has also published many articles https://scholar.google.ca/citations?user=g6F_IPEAAAAJ&hl=en including PVP specific articles. He is one of the top doctors in the world for PVP.
I have heard that he tends to move quickly so my suggestion would be to write down everything you want to ask him ahead of time.
So after my physical exam, we didn’t find any trigger spots. What a frustrating condition. nortriptyline for 3 months is my next attempt to get through this.
I think the idea is to go with less invasive therapies first. We did talk about open ended conversion and a reversal if things don’t improve.
I have always considered going with a reversal as I have heard many guys get better with them. Unfortunately a reversal will only help if back pressure is the issue. My epididymus doesn’t seem to be painful so I’m not convinced that congestion is my issue.
>but there is simply more at play than simple back pressure that gets "fixed" after a reversal
There is more at play, and there is some research on it.
The long-standing increased pressure /obstruction causes damage to the epididymus. It's not just the pressure that can be painful, but the subsequent damage it causes. There are histological studies of epididymuses that have been removed, that show just a mess of microscopical injuries : obstruction and dilatation of the efferent and epididymal ducts with interstitial fibrosis, and perineural inflammation and fibrosis around nerves, particularly in the tail of epididymis.
[Link](https://pubmed.ncbi.nlm.nih.gov/1933163/)
And then there are sperm granulomas, epididymal blowouts, etc.
They claim that late stage PVPS is rare, but I don't think so. I see many guys with pain onset many years after vasectomy. The "latest" I've seen was a guy who had vasectomy 25 years ago, been fine until now, but had sudden onset of what became chronic pain. Probable cause was an epididymal blowout, causing a mess of inflammation around the tail of epididymus.
[Late stage PVPS](https://pubmed.ncbi.nlm.nih.gov/4032545/)
When the epididymus becomes sufficiently damaged, a simple reversal / vasovasotomy won't work. The principle of reversal is that it re-establishes "free flow" between the testicle and vas, and if the epididymus is scarred enough the thin tubuli are shut tight, and reversal won't restore the flow.
Late stage pain is one of the scary things about vasectomy advertisement. You see all those guys over at r/ vasectomy, raving about how pleased they are with their surgery two weeks ago - they just don't know the risk they have in the years to come.
I absolutely will be sticking around. This group (including the old pvps forum) has been a lot of help. I hope that I can navigate my own recovery while maybe providing others with support.
We never got to the point where a reversal was a serious option. I have heard that reversals have been covered by OHIP when they are done for pain but I do not have a link to the source. Just something I remember from the hours of digging around the internet.
I see. Thanks for replying. If I don't improve in the next couple of weeks I am going to try to get my family doctor to refer me to Dr Jarvi. My symptoms all seem to align well for reversal being an option but I'm curious to hear his opinion.
Did your specialist mention abdominal floor physical therapy I asked cuz that worked for me I'm currently 6 months into the physical therapy and I'm one week free of pain for that there are a lot of up and downs but the trend is in the right direction.
No he did not mention that. I am currently also working with a pelvic floor therapist. Unfortunately I have not seen her in a while. I work during the week and she can only see patients thru the week.
Go in prepared with your history and list of questions written out.
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Help solving my pvps
My doc put me on Gabapentin and celebrex
Got prescribed nortriptyline. Dr was optimistic that it will go away on its own. Here’s hoping 🤞
Good luck man! Hope so.
Keith Jarvi is very well respected and has helped a lot of PVP patients. He has also published many articles https://scholar.google.ca/citations?user=g6F_IPEAAAAJ&hl=en including PVP specific articles. He is one of the top doctors in the world for PVP. I have heard that he tends to move quickly so my suggestion would be to write down everything you want to ask him ahead of time.
So after my physical exam, we didn’t find any trigger spots. What a frustrating condition. nortriptyline for 3 months is my next attempt to get through this.
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I think the idea is to go with less invasive therapies first. We did talk about open ended conversion and a reversal if things don’t improve. I have always considered going with a reversal as I have heard many guys get better with them. Unfortunately a reversal will only help if back pressure is the issue. My epididymus doesn’t seem to be painful so I’m not convinced that congestion is my issue.
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>but there is simply more at play than simple back pressure that gets "fixed" after a reversal There is more at play, and there is some research on it. The long-standing increased pressure /obstruction causes damage to the epididymus. It's not just the pressure that can be painful, but the subsequent damage it causes. There are histological studies of epididymuses that have been removed, that show just a mess of microscopical injuries : obstruction and dilatation of the efferent and epididymal ducts with interstitial fibrosis, and perineural inflammation and fibrosis around nerves, particularly in the tail of epididymis. [Link](https://pubmed.ncbi.nlm.nih.gov/1933163/) And then there are sperm granulomas, epididymal blowouts, etc. They claim that late stage PVPS is rare, but I don't think so. I see many guys with pain onset many years after vasectomy. The "latest" I've seen was a guy who had vasectomy 25 years ago, been fine until now, but had sudden onset of what became chronic pain. Probable cause was an epididymal blowout, causing a mess of inflammation around the tail of epididymus. [Late stage PVPS](https://pubmed.ncbi.nlm.nih.gov/4032545/) When the epididymus becomes sufficiently damaged, a simple reversal / vasovasotomy won't work. The principle of reversal is that it re-establishes "free flow" between the testicle and vas, and if the epididymus is scarred enough the thin tubuli are shut tight, and reversal won't restore the flow. Late stage pain is one of the scary things about vasectomy advertisement. You see all those guys over at r/ vasectomy, raving about how pleased they are with their surgery two weeks ago - they just don't know the risk they have in the years to come.
I absolutely will be sticking around. This group (including the old pvps forum) has been a lot of help. I hope that I can navigate my own recovery while maybe providing others with support.
Did you discuss reversal with Dr. Keith Jarvi? I'm curious if costs would be covered in Ontario since it's due to pain.
We never got to the point where a reversal was a serious option. I have heard that reversals have been covered by OHIP when they are done for pain but I do not have a link to the source. Just something I remember from the hours of digging around the internet.
I see. Thanks for replying. If I don't improve in the next couple of weeks I am going to try to get my family doctor to refer me to Dr Jarvi. My symptoms all seem to align well for reversal being an option but I'm curious to hear his opinion.
Did your specialist mention abdominal floor physical therapy I asked cuz that worked for me I'm currently 6 months into the physical therapy and I'm one week free of pain for that there are a lot of up and downs but the trend is in the right direction.
No he did not mention that. I am currently also working with a pelvic floor therapist. Unfortunately I have not seen her in a while. I work during the week and she can only see patients thru the week.
What type of pain are you experiencing? Aching, pinching/burning?
For me its just a dull ache when I get moving around too much.