Microsurgical Spermatic Cord Denervation as a Treatment for Chronic Scrotal Content Pain: A Multicenter Open Label Trial

Marconi, Marcelo; Palma, C.; Troncoso, P.; Oro, Arturo Dell; Diemer, Thorsten; Weidner, W.

doi:10.1016/j.juro.2015.05.081

Cited by 33 publications

(36 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Therefore, the treatment of chronic nonspecific CO is to remove or change the hyperactivated nerve pathways in the spermatic cord, so the targeted MDSC can be a successful option to treat CO. And our results show that targeted MDSC is effective in outcomes. However, numerous studies show variable success rates [1,9,10,23,24]. The PIQ-6 questionnaire showed that most patients had a significant pain relief after MDSC, and only 17.9% of patients continued to have postoperative pain.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2019

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%

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

et al. 2019

View full text Add to dashboard Cite

show abstract

“…In men with a history of previous inguinal hernia or vasectomy who present with a varicocele and pain, a spermatic cord block may be beneficial (18,19). Spermatic cord block with a long acting local anesthetic may aid in diagnosing neuropathic pain in addition to providing guidance as to the type of intervention that may be warranted.…”

Section: Presentation and Evaluationmentioning

confidence: 99%

“…Spermatic cord block with a long acting local anesthetic 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 (19,20). Men who report <50% resolution of symptoms after spermatic cord block may still benefit from varicocele repair, or they may have other mechanisms for pain such as unrecognized pathology, central sensitization, a coexisting pudendal pathway, or even malingering behavior (18).…”

Section: Presentation and Evaluationmentioning

confidence: 99%

A review of varicocele repair for pain

Owen¹,

McCormick²,

Figler³

et al. 2017

Transl. Androl. Urol.

View full text Add to dashboard Cite

A dilation of the pampiniform venous plexus in the scrotum above the testicle, called a varicocele, affects approximately 15% of the general male population. While the majority is asymptomatic, pain results in up to 10% of cases of varicoceles. The pain associated with varicoceles is typically mild and is described as heavy, achy, or dull—and is usually isolated to the testicle or spermatic cord. Guidelines clearly recommend varicocele repair in males with varicoceles, infertility, and an abnormal semen analysis. While chronic, severe pain is an additional indication for repair, a careful evaluation to rule out other etiologies in addition to a period of conservative management are necessary prior to surgical treatment because of the high incidental prevalence of varicoceles in the general population. Several techniques for varicocele repair have been described, including retroperitoneal, laparoscopic, inguinal, and subinguinal. Additionally, recent adjuncts to improve visualization and identification of critical structures including the operating microscope and microvascular Doppler ultrasound have improved success and complication rates. With careful patient selection, outcomes of varicocele repair with regard to pain are excellent, with over 90% of patients experiencing symptomatic relief. After failure of conservative treatments, a varicocele associated with pain should be considered for repair, and the microsurgical subinguinal approach is the gold standard surgical treatment, offering excellent outcomes while minimizing risk of complications.

show abstract

“…They observed no intraoperative complications or testicular units loss but performed two reoperations for hematocele and hydrocele. Their study revealed that six months after surgery, 40 patients (80%) were pain-free, 6 (12%) had persistent pain and 4 (8%) had no change in pain (17). …”

Section: Treatmentmentioning

confidence: 99%

Genital pain: algorithm for management

Calixte¹,

Brahmbhatt²,

Parekattıl³

2017

Transl. Androl. Urol.

View full text Add to dashboard Cite

Chronic testicular pain although becoming very common in our patient population poses a challenge to the physician, the patient and his family. The pathogenesis of chronic orchialgia (CO) is not well understood. The objective of this paper is to review the current literature on chronic testicular pain and its management and to propose an algorithm for its treatment. Abstracts, original papers and review articles were reviewed during a literature search using words such as testicular pain, CO, and microsurgical anatomy of spermatic cord. Chronic scrotal content pain (CSP) is a difficult condition to treat and could be idiopathic or secondary. Conservative therapy is the first line of treatment attempted to allow the patient to return to his routine activities. When conservative treatment fails, patients can now turn toward surgical options such as microsurgical denervation of the spermatic cord (MDSC) which has a success rate published in the 60–85% range and/or minimally invasive therapies such as microcryoablation of the spermatic cord, Botox or Amniofix injection. There is an increase in referrals for CO. The true pathogenesis is still unclear and the road to complete recovery is unsure for certain patients. This paper proposes an algorithm for the management of patients suffering with CO.

show abstract

Microsurgical Spermatic Cord Denervation as a Treatment for Chronic Scrotal Content Pain: A Multicenter Open Label Trial

Abstract: After proper selection of patients microsurgical spermatic cord denervation seems to be a safe and efficient procedure to treat chronic scrotal content pain. Considering the limitations of the study, a randomized, controlled trial with longer followup is highly warranted.

Cited by 33 publications

References 25 publications

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

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

A review of varicocele repair for pain

Genital pain: algorithm for management

Contact Info

Product

Resources

About