Microsurgical Testicular Denervation for the Treatment of Chronic Testicular Pain – Initial Results

Abstract

INTRODUCTION: Chronic testicular pain remains an important challenge for urologists. Currently, the treatment plan is primarily empirical, with the first approach consisting of clinical measures. However, some patients remain in pain despite a conservative treatment protocol and, for them, it is possible to perform a surgical procedure that involves severing the scrotal and spermatic branches of the genitofemoral and ilioinguinal nerve fibers. METHODS: In our institution, 60 patients were evaluated and treated for idiopathic chronic testicular pain between January 2003 and July 2007. Priority was give to clinical treatment, which evolved from simple to more complex measures. Microsurgical treatment was performed on those who experienced no considerable pain relief (10 individuals in our study). RESULTS: Over a twenty-four-month follow-up period, 70% of patients showed complete remission and 20% exhibited partial relief from pain.

Robot-assisted microsurgery for chronic orchialgia

“…MSCD was first reported in 1978 and multiple follow-up studies have shown favorable outcomes with microsurgical techniques (3-6). Historically, MSCD has been performed with the use of the operative microscope.…”

Clinical phenotyping of urologic pain patients

“…Studies have shown complete resolution rates in 70% of patients with chronic orchialgia post-MDSC [34,35]. MDSC is typically offered to patients that have first been shown to have temporary relief of pain after spermatic cord block.…”

Chronic Testicular Pain in Adult Men

“…A visual analog scale is used to measure intensity. Only three of the research articles (Ciftci et al, 2011;de Oliveira et al, 2009;Misra, Ward, & Coker, 2009) and four of the case reports (McJunkin, Wuollet, & Lynch, 2009;Nouri & Brish, 2011;Rosendal, Moir, de Pennington, Green, & Aziz, 2012;Rowell & Rylander, 2012) include the quality of CTP. Sinclair, Miller, and Lee (2007) offer support for a neuropathic origin of CTP and are the first to show that neuromodulating medications decrease pain in chronic orchialgia.…”

“…Men seek evaluation from multiple providers in an attempt to uncover an explanation and treatment for their CTP (Costabile, Hahn, & McLeod, 1991;de Oliveira et al, 2009;Heidenreich, Olbert, & Engelmann, 2002;Planken, Voorham-van der Zalm, Lycklama, Nijeholt, & Elzevier, 2010).…”