Chronic scrotal pain and microsurgical spermatic cord denervation: tricks of the trade

Abstract

Every practicing urologist encounters patients complaining of chronic scrotal content pain (CSCP). This condition can be equally frustrating for both patients and clinicians as there are no clear treatment guidelines, or pathways, for urologists to follow. As a result, most patients typically seek out multiple providers without improvements in their symptoms. Fortunately, microsurgical spermatic cord denervation (MSCD) is becoming an accepted, reliable and reproducible technique for definitively addressing CSCP in select patients. This manuscript reviews the background, effectiveness and current practice guidelines for scrotal pain in general, and MSCD in particular. Technical insights into how this technique can be performed both safely, and efficaciously, are provided. Finally, the manuscript presents a simple, yet detailed, easy to follow treatment algorithm to aid all urologists in the management of patients presenting with chronic pain.

Preoperative Predictors of Failure of Microsurgical Spermatic Cord Denervation for Men With Chronic Orchialgia

“…In the available previous literature, good response rates have been reported with MSCD in men with chronic orchialgia without an anatomic, infectious, or pathologic etiology; however, there is always a failure rate reported, typically of approximately 15% in most series, which leaves clinicians and patients frustrated. 3,4,[6][7][8][9][10][11][12][13][14][15][16] To our knowledge, this is the first study examining the potential reasons for failure of MSCD in carefully selected surgical patients. Therefore, the aim of this study was to identify potential predictors of failure to counsel patients on preoperatively and potentially help understand failure postoperatively.…”

Validation of targeted microsurgical spermatic cord denervation: comparison of outcomes to traditional complete microsurgical spermatic cord denervation

“…first reported MSCD in 1978. Good response rates have been reported in multiple studies since that initial experience 467891011121314. Another anatomic study of the nerves in and in proximity to the spermatic cord has identified sensory and autonomic nerve fibers, most of which were found to be sensory and sympathetic nerve fibers, and few parasympathetic nerve fibers in the spermatic cord and surrounding tissues 15.…”

A Review of the Management of Chronic Scrotal Pain

“…Multiple algorithms for diagnosing and treating CSP have been proposed, but none have been validated [5,6] because it is a difficult condition to manage, and varied practices exist with reference to it. Therefore, our review aimed to: 1) Overview current approaches to the clinical evaluation of CSP.…”