A Clinical Study on Microsurgical Denervation of Spermatic Cord for Refractory Chronic Orchialgia

Abstract

Objectives: Microsurgical denervation of the spermatic cord (MDSC) is a treatment option for chronic orchialgia (CO) refractory to conservative treatment. Studies showed specific nerve fibers as the possible cause of CO. We aimed to present the outcomes of ligation of these nerves using targeted MDSC. Methods: We retrospectively reviewed 30 cases who underwent targeted MDSC from August 2014 to February 2018. Patients included were under strict criteria. Pain was assessed preoperatively and postoperatively using a subjective visual analog scale (VAS) and objectively with the standardized and validated Pain Impact Questionnaire-6 (PIQ-6) score. Results: Data were available on 28 cases at repercussion. During a median follow-up of 12 months (range 10–29), 25 cases (89.2%) showed a significant reduction in pain and 3 (9.8%) had no change in pain by subjective VAS scoring. Of cases with a significant reduction in pain, 15 (53.5%) had complete resolution and 19 (67.9%) had a 50% or greater reduction. Objective PIQ-6 analysis showed a significant reduction in pain in 78.6% of patients at 6 months postoperatively, in 82.1% at 1 year, in 82.1% at 2 years. Conclusions: Targeted MDSC is an effective, minimally invasive approach with potential long-term durability in patients with refractory CO.

Non-pharmacological treatments for chronic orchialgia: A systemic review

“…Thus, 34 studies were included in this systemic review; six prospective, 21 retrospective and seven case series. Most studies reported the results of microsurgical spermatic cord denervation (MSCD) (n = 19) [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27], while the remaining studies investigated the impact of various nerve-blocking techniques (n = 8) [28][29][30][31][32][33][34][35], vasectomy reversal (n = 5) [36][37][38][39][40], and extirpative surgery (n = 2) [41,42].…”

“…The present review identified 19 individual studies including 1676 testicular units for which MSCD was performed. In most cases an open approach for surgery was performed (inguinal [n = 14]; subinguinal [n = 3]; Table 1) [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27]. Depending on the level of the incision, the aponeurosis of the external oblique muscle is either spared or opened.…”

Spermatic vein embolization as a treatment for symptomatic varicocele

“…It is important to try and identify such patients that will not do well post-SVE. One study suggest a spermatic cord block may be beneficial in pre-procedural assessment, in the setting of an inguinal hernia repair or vasectomy who present with a varicocele and pain 29 . Spermatic cord block with a long acting local anaesthetic agent may aid in diagnosing neuropathic pain in addition to providing guidance as to the type of intervention that may be warranted.…”

“…Spermatic cord block with a long acting local anaesthetic agent may aid in diagnosing neuropathic pain in addition to providing guidance as to the type of intervention that may be warranted. For example, if a patient has a greater than 50% reduction in pain after spermatic cord block, microsurgical cord denervation may be an effective treatment option 29 .…”