Spermatic Cord Block Research Articles

PD58-06 WHAT IS THE PREDICTIVE VALUE OF A SPERMATIC CORD BLOCK PRIOR TO MICROSURGICAL DENERVATION OF THE SPERMATIC CORD?

You have accessJournal of UrologyInfertility: Therapy II (PD58)1 Apr 2020PD58-06 WHAT IS THE PREDICTIVE VALUE OF A SPERMATIC CORD BLOCK PRIOR TO MICROSURGICAL DENERVATION OF THE SPERMATIC CORD? Sijo Parekattil*, Ahmet Gudeloglu, Onuralp Ergun, Mohammed Etafy, Nahomy Calixte, Jamin Brahmbhatt, and Richard Mendelson Sijo Parekattil*Sijo Parekattil* More articles by this author , Ahmet GudelogluAhmet Gudeloglu More articles by this author , Onuralp ErgunOnuralp Ergun More articles by this author , Mohammed EtafyMohammed Etafy More articles by this author , Nahomy CalixteNahomy Calixte More articles by this author , Jamin BrahmbhattJamin Brahmbhatt More articles by this author , and Richard MendelsonRichard Mendelson More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000968.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Microsurgical denervation of the spermatic cord (MDSC) has been shown to be a treatment option for men with intractable orchialgia/scrotal content pain. The standard of care is to perform a spermatic cord block to assess if there is any temporary relief in the pain prior to performing MDSC. This study assesses the predictive value of a spermatic cord block (SCB) with local anesthetic in determining post-MDSC outcomes. METHODS: A retrospective review of 1261 MDSC cases (1112 patients, 149 bilateral cases) from October 2008 to July 2019 was performed. An analysis of how the patients who had temporary relief in their pain (greater than 50% reduction) after a spermatic cord block correlated to their final outcome after MDSC was performed. The outcome after MDSC was graded as complete relief (CR) in pain, greater than 50% reduction in pain (PR) or no response (NR), defined as <50% reduction in pain. This outcome was based on preop and post-op measurements of pain using a validated quality of life metric (PIQ-6) and the visual analogue pain score (VAS). RESULTS: The positive predictive value (PPV) of a patient having a response to SCB and then achieving CR or PR was 78%, and achieving CR alone was 41%. The negative predictive value (NPV) of a patient who did not have any relief with SCB, and then achieving NR after MDSC was 57%. CONCLUSIONS: This study illustrates that if a patient has no response to SCB, MDSC is less likely to help reduce pain in these patients. However, a positive response to SCB confers a high likelihood of significant reduction in pain after MDSC. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1202-e1202 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sijo Parekattil* More articles by this author Ahmet Gudeloglu More articles by this author Onuralp Ergun More articles by this author Mohammed Etafy More articles by this author Nahomy Calixte More articles by this author Jamin Brahmbhatt More articles by this author Richard Mendelson More articles by this author Expand All Advertisement PDF downloadLoading ...

MP58-11 A MODIFIED PREOPERATIVE SPERMATIC CORD BLOCK PREDICTS SUCCESS FOLLOWING MICROSCOPIC SPERMATIC CORD DENERVATION SURGERY FOR CHRONIC SCROTAL PAIN

INTRODUCTION AND OBJECTIVE: Chronic scrotal pain is notoriously difficult to treat. After conservative methods have failed, a microscopic spermatic cord denervation (MSCD) procedure has been shown to be effective, but choosing the appropriate candidate is essential. A spermatic cord block has been reported as a predictor for postoperative success. The traditional block includes an injection inferior/medial to the pubic tubercle but may miss contributors to scrotal pain. Here we utilize a modified cord block that targets the 3 primary locations of Wallerian degeneration: cremasteric muscles, vasal sheath and posterior cord fat, and examine its efficacy in predicting postoperative pain. METHODS: All patients presenting with chronic scrotal pain who failed previous treatments were offered the modified block. This was performed by injecting 10mL 0.25% Marcaine circumferentially around the vas deferens and an additional 10mL anterior/medial to the external ring. Pain was assessed using the Numeric Rating Scale (NRS). Patients with 2019 were included in the study. Preoperative, post-block, and 1-month post-surgical pain was assessed. Laterality, age, prior groin surgery, and post-block pain free period were also record. A multivariate linear regression model was used to determine predictors of surgical success. RESULTS: Thirty consecutive patients were tested with the modified block and subsequently underwent MSCD. Mean age was 47 (20-74). Seven patients (23%) had previously undergone vasectomy and 9 (30%) had undergone hernioplasty. Mean post-block pain free period was 5.6hrs (1.5-24). Mean preoperative NRS was 7 (5-9). Following the block, mean pain reduction was 84%, while pain reduction following surgery was 78% (3 <50%; 6 50-69%; 21 clip_image002.png">70%). On multivariate linear regression analysis, reduction in pain following block was an independent predictor of postoperative success (p<0.001). No other factors, including post-block pain free period were statistically significant. CONCLUSIONS: This modified block technique can be utilized as an effective predictor of success following MSCD. Neither prior groin surgery or post-block pain free period were associated with postoperative pain level. A trial comparing this modified approach to traditional spermatic cord block as a method of selecting the optimal surgical candidate is warranted. Source of Funding: none

MP58-10 SPERMATIC CORD BLOCK SERIES AS A TREATMENT FOR CHRONIC SCROTAL CONTENT PAIN

INTRODUCTION AND OBJECTIVE:Chronic Scrotal Content Pain (CSCP) is a common urologic condition with a wide variety of etiologies. Patients who have relief of pain following a spermatic cord block wi...

Spermatic Cord Denervation for Chronic Orchialgia

To review the surgical management of chronic scrotal content pain with microsurgical spermatic cord denervation (MSCD). The data continues to support the use of MSCD for patients with chronic idiopathic scrotal content pain. The use of the robotic approach to this operation is novel but may still be cost-prohibitive and more studies are needed to prove equivalence to the standard microsurgical approach. MSCD has evolved into a very effective treatment for a difficult patient population with few options. It should be considered surgical standard of care for men with persistent chronic scrotal content pain whose symptoms are temporarily resolved with a spermatic cord block.

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.

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

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 ...

Microdenervation of the spermatic cord for post-vasectomy pain syndrome.

To evaluate the outcomes of patients who underwent microdenervation of the spermatic cord (MDSC) for post-vasectomy pain syndrome (PVPS) at our institution. A retrospective study of all patients who underwent MDSC for PVPS by a single surgeon between March 2002 and October 2016 was performed. Pain was documented using the numerical rating scale (NRS). Spermatic cord block (SCB) was performed on all patients, and success was defined as NRS score ≤1 for >4 h. All patients had failed medical therapy prior to MDSC. All previous procedures for PVPS had been performed elsewhere. Surgical success was defined as a postoperative NRS score of ≤1. A total of 27 patients with 28 scrotal units underwent MDSC for PVPS. The median (1st quartile; 3rd quartile) follow-up was 10 (2; 16.5) months. The median (range) duration of pain prior to surgery was 57 (8-468) months. Pain was bilateral in 14 (52%), left-sided in eight (30%) and right-sided in five patients (19%). Data on SCB were available for 23 patients, with a success rate of 96%. The median (range) preoperative pain NRS score was 7 (2-10). The median (range) pain score after SCB on the NRS scale was 0 (0-5). The median (range) postoperative pain score on the NRS was 0 (0-9). Overall success was achieved in 20 of 28 testicular units (71%). Patients with involvement of multiple structures in the scrotum (i.e. testis, epididymis, spermatic cord) had a success rate of 81% and were more likely to have a successful surgery (P < 0.001). Five patients had failed a prior epididymectomy and three had failed a vaso-vasostomy for PVPS; this had no correlation with the success of MDSC (P = 0.89). The MDSC procedure is a reasonably successful, durable and valuable approach for PVPS, especially when pain involves multiple structures in the scrotum (testis, epididymis, spermatic cord). MDSC was equally efficacious in patients who had previously failed a procedure for PVPS. No patient had a worsening NRS score after MDSC. This is the largest study to date evaluating MDSC for the treatment of PVPS.

The value of adding ketamine to lidocaine and bupivacaine mixture in ultrasonic-guided spermatic cord block in scrotal surgery: a randomized double-blind prospective study

Background Spermatic cord block for scrotal surgery avoids the potential risks of neuraxial and general anesthesia and provides long-lasting postoperative analgesia. Aim The aim of this study is to evaluate the value of adding ketamine to lidocaine-bupivacaine mixture for ultrasonic-guided spermatic cord block for patients undergoing scrotal surgery. Patients and methods This study was carried out in Tanta University Hospitals on 50 patients with ASA physical status I and II, age older than or equal to 18 years, who were scheduled for elective scrotal surgery. Patients were randomly allocated into two equal groups using sealed envelopes: 25 patients received ultrasound-guided spermatic cord block by a mixture of lidocaine 5 ml (2%), plain bupivacaine 5 ml (0.5%), and 1-ml normal saline (group 1), and 25 patients received ultrasound-guided spermatic cord block by a mixture of lidocaine 5 ml (2%), plain bupivacaine 5 ml (0.5%), and ketamine (0.5 mg/kg) (group 2). Results There was no significant difference between the demographic data, patient characteristics, heart rate, mean arterial blood pressure, and oxygen saturation in the studied groups. There was significantly rapid onset and prolonged duration of blockade in group 2 and significant increase in visual analog scale score in group 1 at 6 h postoperatively, whereas a significant increase occurred in group 2 at 12 h, postoperatively. There was significant increase in group 1 regarding the amount of rescue analgesia. Conclusion In ultrasound-guided spermatic cord block in scrotal surgery, addition of (0.5 mg/kg) ketamine to lidocaine–bupivacaine mixture improves onset of the block, prolongs postoperative analgesia, and reduces the consumption of postoperative rescue analgesics.

Efficacy of local dexmedetomidine add-on for spermatic cord block anesthesia in patients undergoing intrascrotal surgeries: randomized controlled multicenter clinical trial.

Study objectiveThe objective of this study was to evaluate the effect of adding dexmedetomidine (DEX) to bupivacaine on the quality of spermatic cord block anesthesia and postoperative analgesia.DesignThis is a randomized, double-blind study.SettingThis study was performed in an educational and research hospital.PatientsOne hundred twenty adult males were scheduled for intrascrotal surgeries.InterventionsPatients were divided into two groups: group B received 10 mL of bupivacaine 0.25% for spermatic cord block and intravenous 50 µg of DEX and group BD received 10 mL of bupivacaine 0.25% added to 50 µg of DEX (9.5 mL bupivacaine 0. 25% + 0.5 mL [50 µg] DEX) for spermatic cord block, and for masking purposes, the patients received isotonic saline intravenously.MeasurementsTime to first analgesic request, analgesic consumption, and visual analog scale (VAS) pain score in the first 24 hours postoperatively were assessed.Main resultsTime to first rescue analgesic was significantly delayed in group BD in comparison with group B, median (interquartile) range, 7 (6–12) hours versus 6 (5–7) hours, (p=0.000), the mean cumulative morphine consumption (mg) in the first postoperative 24 hours was significantly lower in group BD compared with group B, 8.13±4.45 versus 12.7±3.79, with a mean difference (95% CI) of −4.57 (−6.06 to −3.07) (p=0.000); also, there was a significant reduction of VAS pain score in group BD in comparison with group B at all measured time points, VAS 2 hours (1.28±0.9 vs 1.92±0.8), VAS 6 hours (2.62±1.5 vs 3.93±1.2), VAS 12 hours (2.40±1.1 vs 3.57±0.65), VAS 24 hours (1.90±0.68 vs 2.53±0.62) (p=0.000)ConclusionThe addition of 50 µg of DEX to bupivacaine 0.25% in spermatic cord block for intrascrotal surgeries resulted in delay of first analgesic supplementation, reduction of postoperative analgesic consumption as well as improvement of the success rate of the block.

Targeted Robotic Assisted Microsurgical Denervation of the Spermatic Cord for the Treatment of Chronic Orchialgia or Groin Pain: A Single Center, Large Series Review

Microsurgical denervation of the spermatic cord is a treatment option for chronic orchialgia refractory to conservative treatment. A recent study showed specific nerve fibers as the possible cause of chronic orchialgia. Our goal was to present the outcomes of ligation of these nerves using a technique of targeted robotic assisted microsurgical denervation of the spermatic cord. We retrospectively reviewed the records of 772 patients who underwent targeted robotic assisted microsurgical denervation of the spermatic cord from October 2007 to July 2016. Selection criteria were chronic testicular pain more than 3 months in duration, failed conservative treatments, negative neurological and urological workup, and temporary resolution of pain with a local anesthetic spermatic cord block. Targeted robotic assisted microsurgical denervation of the spermatic cord was performed. Pain was assessed preoperatively and postoperatively using a subjective visual analog scale and objectively with the standardized and validated PIQ-6 (Pain Impact Questionnaire-6) score. Followup data were available on 860 cases. During a median followup of 24 months (range 1 to 70) 718 cases (83%) showed a significant reduction in pain and 142 (17%) had no change in pain by subjective visual analog scale scoring. Of cases with a significant reduction in pain 426 (49%) had complete resolution and 292 (34%) had a 50% or greater reduction. Objective PIQ-6 analysis showed a significant reduction in pain in 67% of patients 6 months postoperatively, in 68% at 1 year, in 77% at 2 years, in 86% at 3 years and in 83% at 4 years. Targeted robotic assisted microsurgical denervation of the spermatic cord is an effective, minimally invasive approach with potential long-term durability in patients with refractory chronic orchialgia.

PD05-04 EARLY EXPERIENCE WITH MICROSURGICAL SPERMATIC CORD DENERVATION IN A CANADIAN CENTRE

You have accessJournal of UrologyInfections/Inflammation/Cystic Disease of the Genitourinary Tract: Prostate & Genitalia I1 Apr 2017PD05-04 EARLY EXPERIENCE WITH MICROSURGICAL SPERMATIC CORD DENERVATION IN A CANADIAN CENTRE Darby Cassidy Darby CassidyDarby Cassidy More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.353AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Microsurgical spermatic cord denervation (MSCD) is an effective surgical technique to manage chronic medically refractory orchalgia, but has not been widely accepted by Canadian Urologists. This paper reviews the early experience of a single Urologist in Canada METHODS 18 consecutive testicular units underwent MSCD over a 48 months by a single surgeon in a Canadian centre. All patient's had reversible causes of pain ruled out and had a successful diagnostic spermatic cord block. RESULTS A total of 18 patients underwent microsurgical spermatic cord denervation by a single surgeon over 4 years. The average patient age was 45 years. The average pre-procedural pain score was 8.5/10. The average post procedural pain score in respond was 0.4/10. The overall success rates was 83% (15/18), with a complete response seen in 61% (11/18) and a partial but acceptable response in 22% (4/18). The failure rate was 17% (3/18) with these patients demonstrating no significant change in their postoperative pain scores. The complication rate was 11% (2/18) with 1 postoperative testicular loss and 1 postoperative hydrocele. The recurrence rates was also 11% (2/18) with these patients having a recurrence in their pain after 6 months of follow-up. CONCLUSIONS Chronic orchialaia is a challenging entity to treat with poor reported success rates in the literature for both medical and surgical treatments. Our results are consistent with the medical literature. Microsurgical spermatic cord denervation does offer a favourable success rate and acceptable complication rate and should be considered part of the armamentarium for the treatment of chronic medically refractory orchialgia. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e118 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Darby Cassidy More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Anesthetic effects of different volumes of lidocaine for spermatic cord block in cattle

ObjectiveTo evaluate three volumes of lidocaine for spermatic cord block to perform castration in cattle. Study designRandomized blinded clinical study. AnimalsThirty mixed-breed Nellore cattle, aged 28–40 months and weighing 395±21 (352–452) kg [mean±standard deviation (range)]. MethodsCattle were restrained in a chute and allowed to stand without sedation. Three milliliters of 2% lidocaine without epinephrine were infiltrated subcutaneously at each site of scrotal incision in all animals. The animals were allocated to three groups of 10 animals each. Lidocaine 2% was injected into each spermatic cord using a volume of 2, 3 or 4 mL in groups A, B, or C, respectively. The total volumes of lidocaine used were 10, 12, and 14 mL in groups A, B, and C, respectively. The duration of surgery and the retraction of the testicle (scored as positive or negative according to retraction of the testicle) during the procedure were recorded. The data were statistically analyzed by one-way anova followed by Tukey’s and chi-square tests. Differences were considered significant when p<0.05. ResultsThe mean surgical time was shorter in group C than in groups A and B (p<0.001). In groups A, B and C, 90%, 60% and 10% of the animals showed retraction of the testicle, respectively. Fewer animals retracted the spermatic cord in group C than in group A (p=0.002) and B (p=0.02). Conclusions and clinical relevanceOptimal spermatic cord block was achieved by injection of 4 mL of 2% lidocaine 5 minutes before castration and following incisional infiltration of lidocaine, in adult cattle weighing about 400 kg.

Symptomatic male with subclinical varicocele found on ultrasound evaluation.

Subclinical varicocele is a common incidental ultrasound finding detected during evaluation of men with infertility or presenting with chronic scrotal content pain. Studies regarding this disease entity mainly investigated the value of its management in infertile men rather than for pain relief. Current guidelines do not indicate varicocelectomy for subclinical varicocele. Coming across such a diagnosis in the context of chronic orchialgia, the clinician should be careful in ruling out other potentially treatable etiologies. Conservative measures are initially recommended. However, if pain persists, spermatic cord denervation may be an option provided that a favorable response to spermatic cord block has been achieved.

Microsurgical Spermatic Cord Denervation as a Treatment for Chronic Scrotal Content Pain: A Multicenter Open Label Trial

We prospectively evaluated the results of microsurgical spermatic corddenervation in a series of patients with chronic scrotal content painin amulticenter study, including 1 center in Germany and 3 centers in Chile. A total of 50 patients with chronic scrotal content pain more than 3 months in duration were prospectively selected for standardized operative microsurgical spermatic cord denervation as pain treatment. In all patients preoperative management included a positive response to a spermatic cord block test with local anesthesia. Pain severity was assessed using an analog visual pain scale (range 0 to 10) for 30 consecutive days. A total of 52 testicular units were operated on using a subinguinal approach. In all cases a surgical microscope was used to identify the arteria testicularis. No intraoperative complications were observed and no testicular units were lost. Two reoperations were performed, including 1 for hematocele and 1 for hydrocele. Six months after surgery 40 patients (80%) were completely pain-free. In 6 patients (12%) intermittent testicular discomfort persisted, which could be managed by acetaminophen on demand. Four patients (8%) had no change in pain severity after surgery. After proper selection of patients microsurgical spermatic cord denervation seems to be a safe and efficient procedure to treat chronic scrotal content pain. Considering the limitations of the study, a randomized, controlled trial with longer followup is highly warranted.

PD20-08 MICROSURGICAL SPERMATIC CORD DENERVATION FOR CHRONIC SCROTAL CONTENT PAIN: RESULTS OF A MULTICENTER PROSPECTIVE STUDY

You have accessJournal of UrologySexual Function/Dysfunction/Andrology: Surgical Therapy1 Apr 2014PD20-08 MICROSURGICAL SPERMATIC CORD DENERVATION FOR CHRONIC SCROTAL CONTENT PAIN: RESULTS OF A MULTICENTER PROSPECTIVE STUDY Marcelo Marconi, Cristian Palma, Mauricio Olea, Thorsten Diemer, and Wolfgang Weidner Marcelo MarconiMarcelo Marconi More articles by this author , Cristian PalmaCristian Palma More articles by this author , Mauricio OleaMauricio Olea More articles by this author , Thorsten DiemerThorsten Diemer More articles by this author , and Wolfgang WeidnerWolfgang Weidner More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1698AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Introduction and Objectives Microsurgical Spermatic Cord Denervation (MSCD) has become a consented procedure for the treatment of Chronic Scrotal Content Pain (CSCP). Previous reports success rates range from 71% to 100%. Surgical approach can be either performed using a microscope or surgical loupes. Objective: To evaluate in a multicenter (1 Center in Germany, 3 in Chile) prospective series of 40 patients with CSCP, the results of MSCD, using either a loupe assisted approach (magnification 3.5x) or a surgical microscope (magnification 20x) Methods Forty patients with CTP were prospectively enrolled in the study. In order to be a candidate to MSCD all patients meet criteria for CSCP definition and had a positive response to a spermatic cord block test with bupivacaine and no response to a placebo injection (saline solution). Pain severity was measured using an Analog Visual Pain (AVS) scale for the last 30 days (Range 0 -10). The surgery was performed in an ambulatory basis, 13 patients were operated using surgical loupes and 27 using a microscope. Patients were controlled one week, three and six months after surgery with a color doppler ultrasound of the testis. Results A total of 43 testicular units were operated. The mean duration of surgery was 65 minutes (Range 50 – 95 minutes). No intraoperative complications were observed and all patients were operated in an ambulatory basis. No testicular units were lost and the color doppler ultrasound was normal in all cases. Three and six months after surgery 32 patients (80%) were pain free with no need of further oral analgesia. Eight patients (20%) persisted with intermittent testicular discomfort, six could be managed with on demand paracetamol, and two had no change in pain severity. No statistically significant differences were observed between patients operated using loupes or microscope regarding operation time and success rate. Conclusions Microsurgical spermatic cord denervation is a safe procedure with high success rate. The loupe assisted approach is comparable to the classical microscopic approach. © 2014FiguresReferencesRelatedDetailsCited byMarconi M, Palma C, Troncoso P, Dell Oro A, Diemer T and Weidner W (2018) Microsurgical Spermatic Cord Denervation as a Treatment for Chronic Scrotal Content Pain: A Multicenter Open Label TrialJournal of Urology, VOL. 194, NO. 5, (1323-1327), Online publication date: 1-Nov-2015. Volume 191Issue 4SApril 2014Page: e614 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Marcelo Marconi More articles by this author Cristian Palma More articles by this author Mauricio Olea More articles by this author Thorsten Diemer More articles by this author Wolfgang Weidner More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Microsurgical vasovasostomy for the treatment of intractable chronic scrotal pain after vasectomy

Microsurgical vasovasostomy for the treatment of intractable chronic scrotal pain after vasectomy

Does a Positive Response to Spermatic Cord Block Predict Response to Microdenervation of the Spermatic Cord for Chronic Scrotal Content Pain?

Microdenervation of the spermatic cord (MDSC) has been demonstrated to be an effective treatment for men with intractable scrotal content pain. This study evaluates the correlation between a positive response to a spermatic cord block with local anesthetic and the subsequent surgical outcome following MDSC. Pre- and post-cord block pain and pre- and post-MDSC pain. A retrospective review of 74 patients (77 testicular units) who underwent MDSC from 2006 to 2010 was performed. Pre- and post-spermatic cord block pain scores based on a 0-10 visual analog scale (VAS) were compared with pre- and post-MDSC pain scores. A positive response to the block was defined as greater than or equal to 50% temporary reduction of pain based on VAS. The average patient age was 42 years with a mean follow-up of 10 months. The mean duration of symptoms before surgery was 69 months. Mean pre-cord block pain score was 8 with an 89% average decrease in pain following the block. Mean post-MDSC pain score was 2 with an average decrease of 73%. The level of temporary improvement from the cord block appeared to be a useful predictor of sustained improvement with MDSC (P = 0.05). Positive response to spermatic cord block was an independent predictor of MDSC response (P = 0.03). Men with chronic orchialgia who have a positive response to a spermatic cord block are likely to have durable and complete resolution of symptoms after undergoing MDSC. The amount of pain relief obtained after the cord block correlates with pain relief after undergoing a MDSC. Men with chronic orchialgia who desire surgical correction should undergo a preoperative spermatic cord block as part of their complete evaluation. The result of the cord block can help guide the practitioner and the patient toward definitive surgical management via MDSC.

Trifecta Nerve Complex: Potential Anatomical Basis for Microsurgical Denervation of the Spermatic Cord for Chronic Orchialgia

We identified structural abnormalities in the spermatic cord nerves that may explain how microsurgical denervation of the spermatic cord provides pain relief in patients with chronic orchialgia. We retrospectively reviewed a prospective database to compare spermatic cord biopsy specimens from 56 men treated with a total of 57 procedures for microsurgical denervation of the spermatic cord for chronic orchialgia vs a control group of men without pain treated with cord surgery, including varicocelectomy in 4 and radical orchiectomy in 6. Tissue biopsies were obtained from mapped regions of the spermatic cord in all cases. Biopsies stained with hematoxylin and eosin were examined by an independent pathologist. Three human cadaveric spermatic cords were dissected to confirm localization of the nerve distribution identified on pathological mapping. We identified a median of 25 small diameter (less than 1 mm) nerve fibers in the spermatic cord. Of the 57 procedures for orchialgia 48 (84%) showed wallerian degeneration in 1 or more of these nerves but only 2 of 10 controls (20%) had such degeneration (p = 0.0008). In decreasing order of nerve density the 3 primary sites (trifecta nerve complex) of these changes were the cremasteric muscle fibers (19 nerves per patient), perivasal tissues and vasal sheath (9 nerves per patient), and posterior cord lipomatous/perivessel tissues (3 nerves per patient). Cord nerve distribution mapped by the biopsies was confirmed by cadaveric dissection. In men with chronic orchialgia there appears to be wallerian degeneration in reproducible patterns in the spermatic cord nerve fibers. Transection of these nerves may explain the effect of the denervation procedure.

Microdenervation of the Spermatic Cord for Chronic Scrotal Content Pain: Single Institution Review Analyzing Success Rate After Prior Attempts at Surgical Correction

Microdenervation of the spermatic cord is an effective treatment for men with intractable scrotal content pain. We evaluated a single center experience, analyzing patients in whom prior surgical attempts had failed to correct pain who subsequently underwent microdenervation of the spermatic cord. A retrospective chart review of 68 patients who underwent microdenervation of the spermatic cord from 2006 to 2010 was performed. Prior ipsilateral surgical procedures with the intent to correct scrotal content pain were selected, identifying 31 testicular units. Chart review was performed on 68 men with mean age of 42 years at presentation and a mean followup of 10 months. Patients in whom prior surgical correction had failed and who subsequently had microdenervation of the spermatic cord had a mean postoperative pain score of 3 (range 0 to 10) with an average decrease in pain of 67%. Those who had not undergone a prior attempt at surgical correction had a mean post-microdenervation of the spermatic cord pain score of 2 (range 0 to 10) and an average pain decrease of 79% which did not differ statistically from those in whom prior surgery failed. In addition, 50% of men who had undergone surgery before microdenervation of the spermatic cord had complete relief of pain after microdenervation of the spermatic cord vs 64% of those who had not undergone previous surgery. Men with chronic scrotal content pain in whom prior attempts to correct pain have failed have similar, albeit lower, success rates as those without prior surgical intervention. Therefore, men with chronic scrotal content pain in whom prior surgical management has failed and who have a positive spermatic cord block should be considered candidates for microdenervation of the spermatic cord.

Vasectomy reversal with ultrasonography‐guided spermatic cord block

Study Type--Therapy (case series) Level of Evidence 4. What's known on the subject? and What does the study add? Vasectomy reversal is often performed in general or neuraxial anaesthesia. Even though the site of vasectomy reversal is easily amenable to regional/local anaesthesia, spermatic cord blocks are rarely applied because of their risk of vascular damage within the spermatic cord. Recently, we described the technique of ultrasonography (US)-guided spermatic cord block for scrotal surgery, which, thanks to the US guidance, at the same time avoids the risk of vascular damage of blindly performed injections and the risks of general and neuraxial anaesthesia. Vasectomy reversal can easily be done in regional anaesthesia with the newly described technique of US-guided spermatic cord block without the risks of vascular damage by a blindly performed injection and the risks of standard general and neuraxial anaesthesia. In addition, this technique grants long-lasting postoperative pain relief and patients recover more quickly. Microsurgical conditions are excellent and patient satisfaction is high. Thanks to these advantages, more patients undergoing vasectomy reversal might avoid general or neuraxial anaesthesia. • To assess the success rate, microsurgical conditions, postoperative recovery, complications and patient satisfaction of ultrasonography (US)-guided spermatic cord block in patients undergoing microscopic vasectomy reversal and to compare them to a control group with general or neuraxial anaesthesia. • The present study comprised a prospective series of 10 consecutive patients undergoing US-guided spermatic cord block for microscopic vasectomy reversal. • The cohort was compared with 10 patients in a historical control group with general or neuraxial anaesthesia. • Nineteen of 20 (95%) blocks were successful, defined as no pain >3 on the Visual Analogue Scale (VAS), no additional analgesics and/or no conversion to general anaesthesia. Median pain was 0 on the VAS (range 0-5). Additional analgesics were requested in one (5%) block, and there was no conversion to general anaesthesia. • Microsurgical conditions were excellent. • In the spermatic cord block vs general/neuraxial anaesthesia groups, median times (range) between surgery and first postoperative analgesics, alimentation, mobilization and hospital discharge were 12 (2-14) vs 3 (1-6), 1 (0.25-3) vs 4 (3-6), 2 (1-3) vs 6 (3-10), and 4 (3-11) vs 8.5 (6-22) h, respectively. • No complications were reported after the spermatic cord block. • Patient satisfaction was excellent. • US-guided spermatic cord block for microscopic vasectomy reversal is highly successful and provides long-lasting perioperative analgesia. • Times to alimentation, mobilization and hospital discharge are shorter under US-guided spermatic cord block than under general/neuraxial anaesthesia. • Additional anaesthetic pain management might, however, be required unexpectedly with US-guided spermatic cord block.