PD40-03 TARGETED ROBOTIC ASSISTED MICROSURGICAL DENERVATION OF THE SPERMATIC CORD FOR THE TREATMENT OF CHRONIC SCROTAL CONTENT PAIN: SINGLE CENTER, LARGE SERIES REVIEW.

Abstract

You have accessJournal of UrologySexual Function/Dysfunction/Andrology: Surgical Therapy II1 Apr 2015PD40-03 TARGETED ROBOTIC ASSISTED MICROSURGICAL DENERVATION OF THE SPERMATIC CORD FOR THE TREATMENT OF CHRONIC SCROTAL CONTENT PAIN: SINGLE CENTER, LARGE SERIES REVIEW. Bayo Tojuola, Ibrahim Kartal, Jamin Brahmbhatt, and Sijo Parekattil Bayo TojuolaBayo Tojuola More articles by this author , Ibrahim KartalIbrahim Kartal More articles by this author , Jamin BrahmbhattJamin Brahmbhatt More articles by this author , and Sijo ParekattilSijo Parekattil More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2437AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Microsurgical denervation of the spermatic cord (MDSC) is a treatment option for chronic scrotal content pain that is unresponsive to conservative treatments. A recent study has shown specific nerve fiber abnormalities (Wallerian degeneration) in the cord as a potential cause for this pain. Our goal was to assess outcomes of a more targeted technique in ablating only these abnormal nerves when performing MDSC: targeted robotic assisted microsurgical denervation of the spermatic cord (RMDSC). METHODS Retrospective review of 620 patients who underwent RMDSC by two fellowship trained microsurgeons from October 2008 to July 2014. Selection criteria was as follows: chronic testicular pain (>3 months), failed standard pain management treatments and negative urologic workup. Targeted ligation of tissues containing the trifecta location of nerves with Wallerian degeneration was performed: the cremasteric muscle fibers, the peri-vasal sheath and the posterior spermatic cord lipomatous tissues. A robotic microsurgical platform was utilized (DaVinci S, HD with magnification, Intuitive Surgical, Sunnyvale, CA). The primary outcome measure was level of pain. Pain was assessed preoperatively and postoperatively using two assessment tools: a) the subjective visual analog scale (VAS) and b) an objective standardized externally validated pain assessment tool (PIQ-6, QualityMetric Inc., Lincoln, RI). RESULTS Median operative duration (robot console time) was 20 minutes (15-80). Subjective VAS patient pain outcomes: 85% significant reduction in pain (63% complete resolution ¡V 385 patients, 22% reported a greater than 50% reduction in pain ¡V 135 patients). Objective PIQ-6 outcomes: significant reduction in pain in 71% of patients at 6 months and 72% at 1 year post-op. The 4th robotic arm allowed the surgeon to control one additional instrument leading to less reliance on the microsurgical assistant. CONCLUSIONS Targeted robotic assisted microsurgical denervation of the spermatic cord is a safe and viable treatment option for patients with chronic scrotal content pain refractory to conservative measures. Further studies are warranted. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byFurr J and Bowen A (2018) Editorial CommentaryUrology Practice, VOL. 5, NO. 4, (277-277), Online publication date: 1-Jul-2018. Volume 193Issue 4SApril 2015Page: e836 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Bayo Tojuola More articles by this author Ibrahim Kartal More articles by this author Jamin Brahmbhatt More articles by this author Sijo Parekattil More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...