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

Abstract

Introduction Microdenervation of the spermatic cord (MDSC) has been demonstrated to be an effective treatment for men with intractable scrotal content pain. Aim This study evaluates the correlation between a positive response to a spermatic cord block with local anesthetic and the subsequent surgical outcome following MDSC. Main Outcome Measures Pre- and post-cord block pain and pre- and post-MDSC pain. Methods 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. Results 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). Conclusions 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.

Chronic Testicular Pain in Adult Men

“…A consistent definition of CTP is noted among the articles reviewed, based on the Davis et al (1990) definition. The research articles are predominantly retrospective chart reviews, with the largest cohort evaluating 74 men (Benson, Abern, Larsen, & Levine, 2012). A summary of the research studies (Table 1) and case studies (Table 2) is presented.…”

Evaluation and Management of Chronic Scrotal Content Pain

“…The key selection measure for this procedure is a positive yet temporary response to a spermatic cord block. Our center recently demonstrated a strong correlation between a positive response to a spermatic cord block, defined as >50 % temporary reduction of pain, and permanent relief of pain following MDSC [58]. A review of the published literature on MDSC indicates that complete resolution of pain may be expected in approximately 80 % of patients selected based on the criteria specified above, 10-15 % may expect improvement in pain, ∼ 5 % may expect no change, and rarely pain may worsen [59][60][61].…”

A review of varicocele repair for pain

“…In men with a history of previous inguinal hernia or vasectomy who present with a varicocele and pain, a spermatic cord block may be beneficial (18,19). Spermatic cord block with a long acting local anesthetic may aid in diagnosing neuropathic pain in addition to providing guidance as to the type of intervention that may be warranted.…”

“…For example, if a patient has a greater than 50% reduction in pain after spermatic cord block, microsurgical cord denervation may be an effective treatment option (19,20). Men who report <50% resolution of symptoms after spermatic cord block may still benefit from varicocele repair, or they may have other mechanisms for pain such as unrecognized pathology, central sensitization, a coexisting pudendal pathway, or even malingering behavior (18). …”