MP32-08 HIGH INGUINAL MICROSURGICAL DENERVATION OF THE SPERMATIC CORD FOR CHRONIC ORCHIALGIA: A NOVEL APPROACH FOR ADULT AND PEDIATRIC PATIENTS

Abstract

You have accessJournal of UrologySexual Function/Dysfunction: Surgical Therapy II1 Apr 2018MP32-08 HIGH INGUINAL MICROSURGICAL DENERVATION OF THE SPERMATIC CORD FOR CHRONIC ORCHIALGIA: A NOVEL APPROACH FOR ADULT AND PEDIATRIC PATIENTS Koji Shiraishi, Masanori Tabara, Shintaro Oka, and Hideyasu Matsuyama Koji ShiraishiKoji Shiraishi More articles by this author , Masanori TabaraMasanori Tabara More articles by this author , Shintaro OkaShintaro Oka More articles by this author , and Hideyasu MatsuyamaHideyasu Matsuyama More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1058AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Microsurgical denervation of the spermatic cord (MDSC) has been demonstrated to be an effective treatment for men with chronic orchialgia, resulting in up to 70-80% pain relief. To improve the success rate, we have developed a novel approach at the level of the internal inguinal ring for the complete transaction of the nerves running along the inside and around the spermatic cord and evaluated the subsequent surgical outcomes following high inguinal MDSC. METHODS A retrospective review of 50 patients (62 testicular units) who underwent MDSC between 2012 and 2017 was performed. Under general anesthesia, a 3-cm transverse incision was made at the middle of the inguinal canal, and the internal inguinal canal was identified. 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 ligated and transected, except for the testicular artery, lymphatics, vas and vassal artery and vein. A 0-10 visual analogue scale (VAS) was compared with pre- and post-MDSC at 12 months. A positive response to MDSC was defined as greater than or equal to 50%. RESULTS The average patient age was 52 years (range from 12 to 78 years old, including 5 pediatric cases) with a mean follow-up of 28 months. The etiologies of orchialgia were unknown in thirty-seven (74%) patients; five (10%) patients were post-herniorrhaphy; and other patients included cases of infection, trauma, and pelvic surgery. The mean duration of symptoms before surgery was 16 months. The mean operative time was 69 minutes per testicular unit. Mean pre- and post-MDSC pain scores were 8.3 and 2.5, respectively, with an average decrease of 70%. Forty-four (88%) cases showed positive responses after MDSC, and 5 cases (12%) showed no change in response. There was no testicular atrophy or scrotal edema. Negative responses to spermatic cord block, depressive symptoms, and multiple sites of pain, especially perineal pain, were predictors of MDSC failure (p<0.05). CONCLUSIONS For both adult and pediatric patients, high inguinal MDSC for chronic orchialgia is an effective and safe management option for the treatment of chronic orchialgia refractory to medical management. High inguinal MDSC is 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. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e422-e423 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Koji Shiraishi More articles by this author Masanori Tabara More articles by this author Shintaro Oka More articles by this author Hideyasu Matsuyama More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...