High inguinal microsurgical denervation of the spermatic cord for chronic scrotal content pain for pediatric patients

Abstract

ABSTRACT Introduction Microsurgical denervation of the spermatic cord (MDSC) has been demonstrated to be an effective treatment for men with chronic scrotal content pain (CSCP) in adult but not for pediatric patients. Objective The purpose of this study was to investigate the effectiveness and safety, including testicular development, of MDSC for pediatric patients less than 15 years old. Methods A retrospective review of 10 patients who underwent MDSC was performed. A 3-cm transverse incision was made at the middle of the inguinal canal. Macroscopically identified nerves were transected, and the internal surface of the inguinal canal was ablated by bipolar cautery. Under an operating microscope, all the components of spermatic cord were transected, except for the testicular artery, lymphatics, vas system. A 0-10 visual analogue scale (VAS) was compared with pre- and post-MDSC at 12 months. Testicular volume measured by punched-out orchidometer and endocrinological examination was evaluated pre- and post-MDSC at least 12 months. Results The average patient age was 12.7 years (range from 10 to 15 years old). The mean duration of symptoms before surgery was 10 months. The mean operative time was 47 minutes. The mean post-VAS was significantly reduced as compared with pre-VAS (2.1 and 8.7, respectively, p<0.0001). There was no testicular atrophy or scrotal edema. Negative responses to spermatic cord block, depressive symptoms (as screened by the Beck Depression Inventory), and multiple sites of pain were predictors of MDSC failure (p<0.05). Conclusions For both adult and pediatric patients, high inguinal MDSC for CSCP is an effective easier to perform, as it requires fewer divisions of veins and is associated with a larger diameter of the spermatic artery. It also enables complete resection of the nerves, including the nerves running outside the spermatic cord, resulting in high success rates. Disclosure Work supported by industry: no.