MP25-13 MICROSURGICAL DENERVATION OF THE SPERMATIC CORD FOR ORCHIALGIA: RESULTS AND PHENOTYPIC ANALYSIS OF TREATMENT FAILURES

Abstract

INTRODUCTION AND OBJECTIVES: Microsurgical denervation of the spermatic cord is an established technique for chronic orchialgia with variable outcomes. We present our initial results, with an emphasis on the clinical phenotype of patients who did not improve METHODS: Data was extracted from our Men’s Health registry for men with orchialgia who had MDSC between Sept 2010 and Aug 2014. All patients reported temporary resolution of their pain following a cord block with 0.25% bupivacaine. RESULTS: There were 22 procedures in 20 patients (2 staged bilateral). Age ranged from 22 to 62 years (mean 38.5). Symptom duration ranged from 6 to 240 months (median 24). Five patients had prior vasectomy. Other prior surgeries included 3 epididymectomies, 3 orchidopexies and 1 inguinal hernia repair. Four patients had pelvic floor spasm and either declined pelvic floor physical therapy (2) or didn’t improve with therapy (2). At last follow up (range 6-38 months) 15 procedures led to complete pain resolution (68.1%). Of the 7 procedures that did not resolve the pain, 1 patient admitted that the cord block did not work, 2 patients had pelvic floor spasm and refused pelvic floor physical therapy, 1 was resolved following ablation of the genitofemoral nerve and 1 patient was diagnosed with fibromyalgia. There was no significant difference in age or symptom duration by surgical outcome. Surgical complications were minor including 1 patient with scrotal bruising and 1 with prolonged incisional pain CONCLUSIONS: MDSC can provide durable pain relief in a subset of patients with orchialgia with minimal morbidity. Patients with a systemic pain syndrome are unlikely to have resolution by simply removing the initial pain generator and therefore prior to MDSC it is important to demonstrate pain resolution with cord block and to identify and treat any systemic conditions, especially pelvic floor spasm.