Microsurgical Denervation of the Spermatic Cord for Chronic Orchialgia: Long-Term Results From a Single Center

Strom, Kurt H.; Levine, Laurence A.

doi:10.1016/j.juro.2008.05.018

Cited by 96 publications

(95 citation statements)

References 15 publications

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“…The vas deferens is also divided and separated if a previous vasectomy had been performed; if the patient had not had a vasectomy, the vas deferens was stripped of its perivasal tissues for about 2 cm based on the description by Levine and his group at the University of Chicago. 6 …”

Section: Methodsmentioning

confidence: 99%

“…Over the last 2 decades, articles have been published supporting this technique, its efficacy, and its safety in the management of chronic orchialgia. [6][7][8][9][10] The goal of MSCD is to transect, disrupt, and separate all spermatic cord structures that carry neural elements. MSCD also preserves arterial inflow to the testicle and several veins and lymphatics to prevent postoperative testicular congestion and hydrocele formation.…”

Section: Introductionmentioning

confidence: 99%

“…11 The advantages of microsurgical spermatic cord denervation include complete response rates ranging from 71% to 100% -significantly better compared to current medical management and traditional surgical approaches of orchiectomy and epididymectomy. The testis-sparing nature of the procedure reduces the physical and psychological morbidity [6][7][8][9][10] This paper describes the early experience of MSCD at a single centre by a single surgeon.…”

Section: Introductionmentioning

confidence: 99%

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

Cassidy

2015

CUAJ

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Introduction: Microsurgical spermatic cord denervation (MSCD) is an effective surgical technique to manage chronic orchalgia, but it has not been readily adopted by Canadian urosurgeons. This paper reviews the early experience of a single urosurgeon in Canada. Methods: Nine consecutive testicular units underwent MSCD over a 24 month period. These patients underwent MSCD after ruling out reversible causes and after a successful diagnostic spermatic cord block. Results: Of these patients, 77% (7/9) had a complete resolution and 22% (2/9) had a partial resolution of their pain symptoms following MSCD. There were no failures or complications. Conclusions: MSCD is an effective, safe, and reproducible surgical technique that should be included in the treatment armamentarium for chronic orchalgia.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Cassidy

2015

CUAJ

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“…Not all men with pain that causes them to seek medical attention, but it is estimated that this condition may affects up to 100 000 men annually. 9,24,25,28,29 The specific cause for CO is not well understood. The genitofemoral and ilioinguinal nerves provide innervation to the spermatic cord and testicle, and any type or hypersensitivity or irritation of these nerves may lead to CO. Any type of injury, such as infection, trauma, torsion, varicocele, hydrocele, scrotal surgery (most commonly vasectomy) or inguinal hernia repair, could trigger an inflammatory response in the peripheral nerve fibers in this area.…”

Section: Robotic Assisted Targeted Microsurgical Denervation Of the Smentioning

confidence: 99%

Robotic assisted andrological surgery

Parekattıl¹,

Güdeloğlu²

2012

Asian J Androl

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The introduction of the operative microscope for andrological surgery in the 1970s provided enhanced magnification and accuracy, unparalleled to any previous visual loop or magnification techniques. This technology revolutionized techniques for microsurgery in andrology. Today, we may be on the verge of a second such revolution by the incorporation of robotic assisted platforms for microsurgery in andrology. Robotic assisted microsurgery is being utilized to a greater degree in andrology and a number of other microsurgical fields, such as ophthalmology, hand surgery, plastics and reconstructive surgery. The potential advantages of robotic assisted platforms include elimination of tremor, improved stability, surgeon ergonomics, scalability of motion, multi-input visual interphases with up to three simultaneous visual views, enhanced magnification, and the ability to manipulate three surgical instruments and cameras simultaneously. This review paper begins with the historical development of robotic microsurgery. It then provides an in-depth presentation of the technique and outcomes of common robotic microsurgical andrological procedures, such as vasectomy reversal, subinguinal varicocelectomy, targeted spermatic cord denervation (for chronic orchialgia) and robotic assisted microsurgical testicular sperm extraction (microTESE).

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“…Some patients end up in chronic pain clinics and in rare cases orchidectomy or denervation of the spermatic cord [7,8] have been undertaken, often without relief of symptoms. Kumar et al .…”

Section: Introductionmentioning

confidence: 99%

A new approach to the treatment of non‐specific male genital pain

Naim

Ende

2011

BJU International

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OBJECTIVES • To review the literature and the generally accepted unsatisfactory management of chronic genital pain in men. • To refer such patients for Journey psychotherapy and record the outcomes of such treatment. PATIENTS AND METHODS • We describe an alternative psychotherapeutic approach in the treatment of such men, whereby deep‐seated emotions are considered an underlying cause in the expression of chronic genital pain. • Eleven men with refractory chronic genital pain were counselled, and given one Journey process, lasting 2–3 h. • They were followed up for up to 4 years in some cases, and their outcomes recorded. • No further treatment was undertaken in this time. RESULTS • Of the 11 cases, four had significant pain relief, four had partial relief of their symptoms, and three did not (or may have had some relief but were lost to follow‐up). CONCLUSION • Chronic genital pain syndromes are common and often debilitating. Patients are subject to an array of investigations that usually identify non‐specific abnormalities at best. Treatment is usually aimed at symptomatic control as underlying organic pathology is rarely identified. Patients have been given multiple courses of antibiotics even in the absence of identifiable organisms, anti‐inflammatory drugs in the absence of proven inflammation, and narcotic analgesics in an attempt to control chronic pain. Occasionally surgery, such as orchidectomy, has been performed to remove the painful organ, without satisfactory results. We therefore looked for an alternative approach that had the promise of a more satisfactory outcome. • Given the usual psychotherapeutic requirement of lengthy periods of therapy, and given that each patient only had one session, we find the above results remarkable and very encouraging. • With this experience, we now offer this approach early to avoid wasting time and money, and would persist with further therapy sessions especially in those with partial relief of their pain.

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Microsurgical Denervation of the Spermatic Cord for Chronic Orchialgia: Long-Term Results From a Single Center

Abstract: Microsurgical denervation of the spermatic cord is a minimally invasive, effective and durable management option for treatment of chronic orchialgia refractory to medical management, preserving the physiological function and psychological role of the testes.

Cited by 96 publications

References 15 publications

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

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

Robotic assisted andrological surgery

A new approach to the treatment of non‐specific male genital pain

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