Presentation Authors: Sarah Vij, Neel Parekh, Daniel Shoskes*, Cleveland, OH
Introduction: Microsurgical denervation of the spermatic cord (MDSC) can be helpful for chronic orchialgia but predictors of clinical success are not clearly established. We present our clinical results with an emphasis on predictors of failure of pain resolution.
Methods: Data was extracted from our Men's Health registry for men with orchialgia who had MDSC between Sept 2010 and Aug 2018. All patients had unexplained scrotal contents pain for at least 4 months and reported temporary resolution of their pain following a cord block with lidocaine and bupivacaine.
Results: There were 72 procedures in 61 patients (11 staged bilateral). Age ranged from 20 to 71 years (mean 41.9). Symptom duration ranged from 4 to 480 months (median 24). 12 patients had prior vasectomy and 35 patients had no prior genital surgery. At last follow up (range 3 months-7 years) 61 procedures led to complete pain resolution (84.7%). In men with post-vasectomy pain, 10 of 12 were successful (83%). Of the 11 procedures that did not resolve pain, 3 patients admitted the cord block did not fully work and 4 patients had unresolved pelvic floor spasm. There was no difference in age or symptom duration by surgical outcome. Surgical complications included 1 orchiectomy (patient had 2 prior surgeries), 1 hydrocele and 2 superficial wound infections. In 8 patients with complex anatomy and/or scarring we performed a more limited targeted dissection popularized by Parekattil et al in which only the spermatic fascia, vas and posterior fat were divided or stripped. In these men pain resolved in 7 cases (87.5%)
Conclusions: MDSC can provide durable pain relief in most patients with orchialgia with minimal morbidity. Age, duration, prior vasectomy or a targeted limited dissection did not adversely impact outcome. Failure of cord block to eliminate pain and presence of pelvic floor spasm were the strongest predictors of persistent pain