1880 TRIFECTA OF PAIN: ANATOMIC BASIS FOR DENERVATION OF THE SPERMATIC CORD FOR CHRONIC ORCHIALGIA

Abstract

You have accessJournal of UrologyInfertility: Physiology, Pathophysiology, Basic Research1 Apr 20101880 TRIFECTA OF PAIN: ANATOMIC BASIS FOR DENERVATION OF THE SPERMATIC CORD FOR CHRONIC ORCHIALGIA Sijo Parekattil, Karen Priola, Hany Atalah, Marc Cohen, Johannes Vieweg, and Robert Allen Sijo ParekattilSijo Parekattil More articles by this author , Karen PriolaKaren Priola More articles by this author , Hany AtalahHany Atalah More articles by this author , Marc CohenMarc Cohen More articles by this author , Johannes ViewegJohannes Vieweg More articles by this author , and Robert AllenRobert Allen More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1833AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Levine et al. have shown that microsurgical denervation of the spermatic cord is a treatment option for men with chronic orchialgia (CO). Uceyler et al. have shown that patients with neuropathic pain may have Wallerian degeneration in peripheral nerves. This study was aimed at developing an anatomical basis of how the denervation technique may provide pain relief. METHODS A prospective control study was performed. Specimens of tissue transected in a standardized fashion from cross-sections of the spermatic cord during 30 microsurgical denervation procedures and 4 varicocelectomies performed (May to Oct 2009) by a single microsurgeon (SJP) were reviewed. All specimens were reviewed by a single pathologist (RWA), blinded to the tabulated results of total number of nerves, size and any evidence of pathology (hematoxylin-eosin staining). All denervation cases were performed in men with CO that had failed conservative treatment options (negative urologic and neurologic workup). The 4 varicocelectomy cases were the control group (no CO). A human cadaver dissection was performed to confirm localization of the nerve distribution found on pathology. RESULTS There were an average of 20 reproducible small diameter (<1 mm) nerve fibers within the spermatic cord per patient. 83% (25/30) of orchialgia patients were found to have Wallerian degeneration in at least one or more of these nerves. Only 25% (1/4) patients had Wallerian degeneration in the varicocelectomy group. There was a characteristic distribution of nerves within the cord. There were 3 primary locations, listed in decreasing order of nerve density: 1) Cremasteric muscle fibers (8 nerves/patient), 2) Peri-vasal tissues and vasal sheath (7.6 nerves/patient), and 3) Peri-arterial tissues (1.9 nerves/patient). The nerve distribution was anatomically confirmed on the cadaver dissection. CONCLUSIONS There is an anatomical basis to the success of microsurgical denervation of the spermatic cord for men with chronic orchialgia. There appear to be specific distribution patterns of small diameter nerve fibers within the spermatic cord. There appears to be a significant amount of Wallerian degeneration in spermatic cord nerve fibers in men with chronic orchialgia. This study confirms the key components of the denervation procedure: 1) ligation of cremasteric fibers, 2) ligation of the peri-vasal sheath, and 3) ligation of the peri-arterial tissues. The transsection of these nerves may explain the effect of the denervation procedure. Gainesville, FL© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byLarsen S, Benson J and Levine L (2012) Microdenervation of the Spermatic Cord for Chronic Scrotal Content Pain: Single Institution Review Analyzing Success Rate After Prior Attempts at Surgical CorrectionJournal of Urology, VOL. 189, NO. 2, (554-558), Online publication date: 1-Feb-2013. Volume 183Issue 4SApril 2010Page: e730-e731 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sijo Parekattil More articles by this author Karen Priola More articles by this author Hany Atalah More articles by this author Marc Cohen More articles by this author Johannes Vieweg More articles by this author Robert Allen More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...