Early experience with microsurgical spermatic cord denervation for chronic orchialgia at a Canadian centre

Cassidy, Darby

doi:10.5489/cuaj.2383

Cited by 19 publications

(18 citation statements)

References 10 publications

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“…first reported MSCD in 1978. Good response rates have been reported in multiple studies since that initial experience 467891011121314. Another anatomic study of the nerves in and in proximity to the spermatic cord has identified sensory and autonomic nerve fibers, most of which were found to be sensory and sympathetic nerve fibers, and few parasympathetic nerve fibers in the spermatic cord and surrounding tissues 15.…”

Section: Discussionmentioning

confidence: 95%

Validation of targeted microsurgical spermatic cord denervation: comparison of outcomes to traditional complete microsurgical spermatic cord denervation

Kavoussi

2019

Asian J Androl

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The aim of this study was to validate the effectiveness of targeted microsurgical spermatic cord denervation (MSCD) of the trifecta nerve complex in comparison to traditional full MSCD with complete skeletonization of the spermatic cord in men with chronic orchialgia. Retrospective chart review was performed by a single fellowship-trained microsurgeon between 2011 and 2016. Patients had follow-ups at 6 weeks, 6 months, and 1 year postoperatively. Thirty-nine men with chronic orchialgia underwent full MSCD between 2011 and 2013. In July 2013, after the publication of an anatomic study with identification of Wallerian degeneration of the trifecta nerve complex in men with chronic orchialgia, the technique was changed to targeted MSCD. From July 2013 to March 2016, 43 men underwent targeted MSCD. When comparing the full MSCD group to the targeted MSCD group, there was no significant difference in resolution of pain (66.7% vs 69.8%, P = 0.88), no difference in partial relief of pain (17.9% vs 23.3%, P = 0.55), and no difference in failure to respond rates (15.4% vs 7.0%, P = 0.22) between the two groups. There was no difference in mean change of visual analog pain scale scores between the two groups ( P = 0.27). Targeted MSCD had a shorter operative time (53 min vs 21 min, P = 0.0001). Targeted MSCD offers patients comparable outcomes to traditional full MSCD, with a shorter operative time, a less technically challenging surgery, and potentially less risk to cord structures which should be preserved.

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Section: Discussionmentioning

confidence: 95%

Validation of targeted microsurgical spermatic cord denervation: comparison of outcomes to traditional complete microsurgical spermatic cord denervation

Kavoussi

2019

Asian J Androl

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“…And it is thought to represent neural changes in the peripheral and central system, which enable persistent stimulation of pain centers in the absence of threshold stimulation. As such, chronic pain syndromes can occur anywhere, including the testicle or the scrotum [20,21]. More complex and centrally located pathologies may also be responsible for the pain, such as musculoskeletal injury, particularly of the lumbosacral region [9].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2019

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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.

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“…Numerous groups have published success rates ranging from 77–100% in terms of significant reduction or elimination of pain. 18 , 21 , 22 , 47 , 62 The trifecta nerve complex mentioned in the pathophysiology section above explains the benefit of MDSC in CSP patients. Ligation of the nerves with Wallerian degeneration in the trifecta is likely to provide pain relief or reduction in CSP patients undergoing MDSC.…”

Section: Treatment Algorithm For Chronic Orchialgia or Chronic Scrotamentioning

confidence: 99%

<p>Management of Chronic Orchialgia: Challenges and Solutions – The Current Standard of Care</p>

Parekattıl¹,

Ergun²,

Güdeloğlu³

2020

RRU

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Introduction Chronic scrotal content pain (CSP) or chronic orchialgia can be debilitating for patients and difficult to treat. There is a paucity of structured treatment algorithms to approach this difficult condition. Methods A review of the literature was performed. Conservative treatment options are presented and then targeted surgical interventions that the urologist may perform are then presented in a structured algorithm format. Many of these patients may obtain a significant reduction in pain with some of these treatments. Results This review presents the pathophysiology, a new assessment tool, and various treatment options available for CSP patients, such as targeted spermatic cord blocks, targeted and standard microsurgical denervation of the spermatic cord (77–100% success rates), ultrasound-guided peri-spermatic cord and ilioinguinal cryoablation (59–75% success rates), scrotox (botox) (56–72% success rates), targeted ilioinguinal and iliohypogastric peripheral nerve stimulation (72% success rate), radical orchiectomy (20–75% success rate), targeted robotic-assisted intra-abdominal denervation (71% success rate) and vasectomy reversal (69–100% success rates). Conclusion A structured and evidence-based approach to help urologists manage patients with chronic orchialgia or scrotal content pain is presented.

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Early experience with microsurgical spermatic cord denervation for chronic orchialgia at a Canadian centre

Cited by 19 publications

References 10 publications

Validation of targeted microsurgical spermatic cord denervation: comparison of outcomes to traditional complete microsurgical spermatic cord denervation

Validation of targeted microsurgical spermatic cord denervation: comparison of outcomes to traditional complete microsurgical spermatic cord denervation

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

<p>Management of Chronic Orchialgia: Challenges and Solutions – The Current Standard of Care</p>

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