Microsurgical Denervation of Spermatic Cord for Chronic Idiopathic Orchialgia: Long-Term Results from an Institutional Experience

Abstract

Purpose: Chronic testicular pain remains an important challenge for urologists. At present there are many treatment modali-ties available for chronic orchialgia. Some patients remain in pain despite a conservative treatment. Microsurgical denerva-tion of spermatic cord appears to be successful in relieving pain in patients who fail conservative management. We assessed the long-term efficacy, complications and patient perceptions of microsurgical denervation of the spermatic cord in the treat-ment of chronic orchialgia. Materials and Methods: A prospective study was conducted from January 2007 to January 2016 which included men with testicular pain of >3 months duration, failure of conservative management, persistent of pain for >3 months after treating the underlying cause. Total 48 patients with 62 testicular units (14 bilateral) showed the response to spermatic cord block and underwent microsurgical denervation of spermatic cord. Results: Out of 62 testicular units (14 bilateral) which were operated, complete 2 years follow-up data were available for 38 testicular units. Out of these 38 units, 31 units (81.57%) had complete pain relief, 4 units (10.52%) had partial pain, and 3 units (7.89%) were non-responders. Complications were superficial wound infection in 3 units (4.83%), hydrocele in 2 units (3.22%), subcutaneous seroma in 2 units (3.22%), and an incisional hematoma in 1 unit (1.61%) out of 62 operated testicu-lar units. Conclusions: Idiopathic chronic orchialgia remains a difficult condition to manage. If surgery is considered, microsurgical denervation of spermatic cord should be considered as a first surgical approach to get rid of pain and sparing the testicle.

Keywords

• Chronic pain
• Denervation
• Pain management
• Scrotum
• Spermatic cord
• Testis