PD45-09 SCROTOX: SALVAGE PERI-SPERMATIC CORD BOTULINUM-A TOXIN INJECTIONS FOR PATIENTS WITH REFRACTORY CHRONIC SCROTAL CONTENT PAIN AFTER MICROSURGICAL DENERVATION OF THE SPERMATIC CORD.

Abstract

You have accessJournal of UrologySexual Function/Dysfunction/Andrology: Medical and Non-Surgical Therapy II1 Apr 2015PD45-09 SCROTOX: SALVAGE PERI-SPERMATIC CORD BOTULINUM-A TOXIN INJECTIONS FOR PATIENTS WITH REFRACTORY CHRONIC SCROTAL CONTENT PAIN AFTER MICROSURGICAL DENERVATION OF THE SPERMATIC CORD. 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.2015.02.2581AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Botulinum-A toxin (Botox) has been shown to modulate the release of neuropeptides leading to inhibition of neurogenic inflammation and chronic pain. This provides an antinociceptive effect. Chronic scrotal content pain is a difficult condition to treat. Microsurgical denervation of the spermatic cord (MDSC) is one surgical treatment option with success rates published in the 60-85% range. However, patients who fail MDSC have limited options. Our goal was to assess the use of peri-spermatic cord Botox injections (Scrotox) to provide prolonged pain relief in men with refractory chronic scrotal content pain after MDSC. METHODS Retrospective review of 25 patients who underwent Scrotox (29 procedures: 4 bilateral, 10 right side, 11 left side) from July 2013 to July 2014. All patients had failed prior MDSC. 100 units of Botox diluted in 10cc of saline was injected medial and lateral to the spermatic cord at the level of the external inguinal ring to ablate branches of the genitofemoral, ilioinguinal and inferior hypogastric nerves. The primary outcome measure was the 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 age was 43 years. Median duration of pain prior to the procedure was 10 years. Median operative duration was 15 minutes. Median follow up post procedure was 8 months. Subjective VAS patient pain outcomes: 70% significant reduction in pain (14% complete resolution, 56% reported a greater than 50% reduction in pain). Objective PIQ-6 outcomes: significant reduction in pain in 40% of patients at 6 months and 20% at 1 year post-op. There were no complications in our small cohort. CONCLUSIONS Scrotox is a potentially safe and viable treatment option for the salvage management of persistent chronic scrotal content pain in patients who have failed MDSC. Further studies are warranted to better understand the long-term durability of this treatment modality. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e905 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 ...