(504) Subinguinal Microsurgical Cremasteric Muscle Division for Painful Retractile Testis: Single Center Experience

Abstract

Abstract Introduction Cremasteric muscle division or release is a procedure performed in patients with chronic orchialgia associated with hyperactive cremaster muscle reflex who do not respond to medical therapy. This condition was first described in the literature by Dr. Thomas in 1927 and the first procedures releasing or removing cremaster muscle were first described in the 1930s. Nowadays, cremasteric muscle division is usually performed with a surgical microscope to improve accuracy and avoid injury of cord structures. However, data about outcomes of this procedure are sparse. To our knowledge, the only series of cases was reported by Dr. Kavoussi in 2019 who reported resolution of retraction in 100% of the patients that had this procedure and resolution of orchialgia in 92% of them. Objective Our main objective was to describe and evaluate outcomes of microsurgical cremasteric muscle division in a men’s health practice in Boston, MA and to determine if prior results described in the literature are similar to our current experience. Methods We performed a retrospective review of cases performed in our institution between 2018-2022 and recorded different outcomes including post-operative pain, post-operative physical exam, ED visits and complications. Results We performed a total of 4 cremasteric muscle divisions for unilateral retractile testis in 3 and bilateral retractile testis in 1 of the patients. All of the cases had retraction of the testis with reproducible findings on preop physical exam, and all of them endorsed pain and discomfort associated with retraction. The patient age ranged 21 to 56. All cases were performed using a surgical microscope. After a median follow-up of 52 days, 100% of the patients had improvement in the position of the testicle with no further episodes of retraction, and 75% (3/4) had complete resolution of pain. Regarding complications, only 1 patient had an episode of mild epididymitis that improved with a short course of NSAIDS and there were no visits to the emergency department or other complications. Conclusions Our experience is similar to prior case series reported in the literature showing resolution of testicular retraction in all the patients that had microsurgical cremasteric muscle release and resolution of pain in the majority of the cohort with a low rate of post-operative complications. Future multicenter studies with a larger sample size should be performed to confirm these results, compare outcomes to other more conventional approaches such as scrotal orchiopexy, and to explore preoperative characteristics associated failure to resolve pain. In addition, future studies should assess differences in outcomes in procedures using surgical microscope compared to the traditional open approach. Disclosure No