Microsurgical Denervation Of Spermatic Cord Research Articles

MP58-09 SERIAL SPERMATIC CORD INJECTIONS WITH TRIAMCINOLONE FOR CHRONIC TESTICULAR PAIN

INTRODUCTION AND OBJECTIVE:Chronic testicular pain remains a challenging problem for both patients and urologists, for which microsurgical denervation of spermatic cord (MDSC) has proven to be a su...

A Clinical Study on Microsurgical Denervation of Spermatic Cord for Refractory Chronic Orchialgia

Objectives: Microsurgical denervation of the spermatic cord (MDSC) is a treatment option for chronic orchialgia (CO) refractory to conservative treatment. Studies showed specific nerve fibers as the possible cause of CO. We aimed to present the outcomes of ligation of these nerves using targeted MDSC. Methods: We retrospectively reviewed 30 cases who underwent targeted MDSC from August 2014 to February 2018. Patients included were under strict criteria. Pain was assessed preoperatively and postoperatively using a subjective visual analog scale (VAS) and objectively with the standardized and validated Pain Impact Questionnaire-6 (PIQ-6) score. Results: Data were available on 28 cases at repercussion. During a median follow-up of 12 months (range 10–29), 25 cases (89.2%) showed a significant reduction in pain and 3 (9.8%) had no change in pain by subjective VAS scoring. Of cases with a significant reduction in pain, 15 (53.5%) had complete resolution and 19 (67.9%) had a 50% or greater reduction. Objective PIQ-6 analysis showed a significant reduction in pain in 78.6% of patients at 6 months postoperatively, in 82.1% at 1 year, in 82.1% at 2 years. Conclusions: Targeted MDSC is an effective, minimally invasive approach with potential long-term durability in patients with refractory CO.

Microsurgical Denervation of Spermatic Cord for Chronic Idiopathic Orchialgia: Long-Term Results from an Institutional Experience.

PurposeChronic testicular pain remains an important challenge for urologists. At present there are many treatment modalities available for chronic orchialgia. Some patients remain in pain despite a conservative treatment. Microsurgical denervation of spermatic cord appears to be successful in relieving pain in patients who fail conservative management. We assessed the long-term efficacy, complications and patient perceptions of microsurgical denervation of the spermatic cord in the treatment of chronic orchialgia.Materials and MethodsA prospective study was conducted from January 2007 to January 2016 which included men with testicular pain of >3 months duration, failure of conservative management, persistent of pain for >3 months after treating the underlying cause. Total 48 patients with 62 testicular units (14 bilateral) showed the response to spermatic cord block and underwent microsurgical denervation of spermatic cord.ResultsOut of 62 testicular units (14 bilateral) which were operated, complete 2 years follow-up data were available for 38 testicular units. Out of these 38 units, 31 units (81.57%) had complete pain relief, 4 units (10.52%) had partial pain, and 3 units (7.89%) were non-responders. Complications were superficial wound infection in 3 units (4.83%), hydrocele in 2 units (3.22%), subcutaneous seroma in 2 units (3.22%), and an incisional hematoma in 1unit (1.61%) out of 62 operated testicular units.ConclusionsIdiopathic chronic orchialgia remains a difficult condition to manage. If surgery is considered, microsurgical denervation of spermatic cord should be considered as a first surgical approach to get rid of pain and sparing the testicle.

Microsurgical denervation of rat spermatic cord: safety and efficacy data

To describe a microsurgical technique for denervation of the spermatic cord and use of multiphoton microscopy (MPM) laser to identify and ablate residual nerves after microsurgical denervation. To evaluate structural and functional changes in the rat testis and vas deferens after denervation. Nine Sprague-Dawley rats were divided into three experimental groups: sham, microsurgical denervation of the spermatic cord (MDSC), and MDSC immediately followed by laser ablation with MPM. At 2 months after surgery, we assessed testicular volume, functional circulation of the testicular artery with Doppler, patency of the vas deferens, and histology of the testis and vas deferens. There was a significant decrease in the median number of nerves remaining around the vas deferens with MDSC alone (3.5 nerves) or MDSC with MPM (1.5 nerves) compared with sham rats (15.5 nerves) (P = 0.003). Although, MDSC with MPM resulted in the fewest remaining nerves, this result was similar to MDSC alone (P = 0.29). No deleterious effects on spermatogenesis or vas patency were seen in the experimental groups when compared with the sham rats. A microsurgical approach can be used to effectively and safely denervate the rat spermatic cord with minimal changes to structure and function of the testis and vas deferens. MPM can be used as an adjunct to identify and ablate residual nerves after MDSC.

Microsurgical denervation of the rat spermatic cord and its connection to the diagnosis and treatment of chronic orchialgia: a bench to bedside experience.

Chronic orchialgia is a common urologic problem, however, determination of the etiology is often difficult and the pathophysiology is poorly understood. As a result, there is no clear algorithm for surgical treatment for men who have failed conservative medical treatment. This review aims to describe microsurgical denervation of the rat spermatic cord (SC) and summarize several surgical techniques that have been described in the literature ranging from orchiectomy to epididymectomy to vasectomy reversal for post-vasectomy orchialgia. More recent studies advocate for microsurgical denervation of the spermatic cord (MDSC), which can be performed with a standard operating microscope or laparoscopic/robotic techniques providing optical magnification. Data regarding efficacy and complications for all surgical treatments is outlined. Experimental modalities, such as the use of multiphoton microscopy (MPM) to identify and ablate nerves surrounding the vas deferens are also described. Finally, given the fact that chronic orchialgia often affects young men, we summarize safety data generated from an animal model regarding the effect of microsurgical denervation on the structure and function of the testis and vas deferens.

The perioperative nursing of microsurgical denervation of the spermatic cord to treat idiopathic chronic orthialgia

Objective To summarize the perioperative nursing experience of microsurgical denervation of the spermatic cord to treat idiopathic chronic orthialgia.Methods We retrospectively analyzed the clinical record data of two patients with idiopathic chronic orthialgia,who received microsurgical denervation of the spermatic cord in our hospital,including pre-and postoperative symptom scores,evaluation of mental state and wound nursing.Results Both patients got complete pain relief and were discharged one week after operation.No would infection and mental fluctuation was noted.Conclusions The reasonable individual perioperative nursing is an elemental component of recovery for patients with chronic orthialgia who experienced microsurgical management. Key words: Idiopathic chronic orthialgia; Microsurgical denervation; Perioperative nursing

S118 MODIFIED NESBIT PROCEDURE FOR TREATING VENTRAL PENILE CURVATURE: OUTCOMES OF TWO DIFFERENT DISSECTION TECHNIQUES OF NEUROVASCULAR BUNDLE (NVB)

Eight patients (26%) had pain following hernia surgery, 4 patients (13%) had post-vasectomy pain syndrome, and 19 patients had idiopathic orchalgia. Patients were examined post-operatively to assess numbness of the testicle (technical success) as well as patient-reported symptomatic improvement (reported as % improvement from baseline). RESULTS: Mean patient age was 45.8 years (range 18–69 years). Mean follow-up was 14.6 months (range 1 to 35 months). Symptomatic improvement of 50% was seen in 4 testicles (11.7%), 75% improvement in 7 (20.6%), and 90–100% improvement in 16 (47.1%). Five testicular units (14.7%) did not improve, and 2 patients who initially improved had return of sensation at 4 and 6 months. One of these patients was treated successfully with orchiectomy. Two patients did not return for their post-op visits and were lost to follow-up. No post-op hydroceles were seen. Complications included testicular atrophy in 2 patients, cord hematoma in 1 patient, and post-op urinary retention in 1 patient. CONCLUSIONS: For appropriately-selected patients, microsurgical denervation of the spermatic cord is an effective treatment of chronic testicular pain refractory to medical therapy.