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

Calixte, Nahomy; Tojuola, Bayo; Kartal, İbrahim; Güdeloğlu, Ahmet; Hirsch, Matthew; Etafy, Mohamed; Mendelson, Richard; Djokić, Borivoje; Sherba, Sarah; Shah, Kunal Ajitkumar; Brahmbhatt, Jamin; Parekattıl, Sıjo J.

doi:10.1016/j.juro.2017.10.030

Cited by 31 publications

(24 citation statements)

References 21 publications

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“…Therefore, the treatment of chronic nonspecific CO is to remove or change the hyperactivated nerve pathways in the spermatic cord, so the targeted MDSC can be a successful option to treat CO. And our results show that targeted MDSC is effective in outcomes. However, numerous studies show variable success rates [1,9,10,23,24]. The PIQ-6 questionnaire showed that most patients had a significant pain relief after MDSC, and only 17.9% of patients continued to have postoperative pain.…”

Section: Discussionmentioning

confidence: 99%

“…A standard MDSC needs (1) identification of the testicular, cremasteric, and deferential arteries, (2) ligation of the internal spermatic veins, (3) division of all cremasteric musculature and spermatic cord fascia, and (4) preservation of a few lymphatics [9,10]. Parekattil et al [2] performed a study comparing patients with CO to those without.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2019

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2019

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“…A significant barrier to the scientific evaluation of a condition and its treatment is the lack of a standardized and validated way to assess and quantify symptoms. Currently, the orchialgia literature uses subjective measures of patient improvement, visual analogue scales for pain or other pain instruments not designed or validated for this type of pain such as the PIQ-6 ( 4 ). Furthermore, simple pain scales may fail to incorporate other features of the condition that also impact QOL.…”

Section: Discussionmentioning

confidence: 99%

“…The development of validated symptom scores is especially important in subjective disorders; development of such instruments in voiding dysfunction, sexual dysfunction and prostatitis has led to more widespread scientific study in these conditions. Most studies to date have either used a trinary “gone”, “improved” or “unchanged” outcome ( 3 ) or a pain scale not validated for orchialgia ( 4 ). This may fail to adequately encompass the patient experience in chronic pain disorders, which can represent a complex interaction of a constellation of symptoms.…”

Section: Introductionmentioning

confidence: 99%

Development of a clinically relevant symptom index to assess patients with chronic orchialgia/chronic scrotal content pain

Polackwich¹,

Arora²,

Li³

et al. 2018

Transl. Androl. Urol.

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BackgroundThe purpose of this study was to develop a candidate symptom index for men with an established diagnosis of chronic orchialgia.MethodsBased on interviews with patients and providers, we developed a 70-item questionnaire that focused on seven areas of orchialgia symptoms: pain, location, urinary symptoms, sexual dysfunction, medical history and quality of life (QOL) impact. The questionnaire was completed by patients at two medical centers. Cluster analysis was performed with the software package R (3.2.1).ResultsA total of 113 men completed the survey. Median symptom duration was 12 months (range, 3–336 months). Outside the testicle, pain was felt in the spermatic cord (66%), groin (66%), penis (24%), suprapubic region (38%), flank (31%), thigh (32%), abdomen (36%) and perineum (35%). Bother scores were high only for testicle and spermatic cord pain. Urinary frequency was common (54%) but not bothersome. Sexual dysfunction was common: 55% had erectile dysfunction, 56% had decreased libido and 39% had painful ejaculation with high bother for all. By cluster analysis, QOL parameters clustered tightly with minimal pain level, pain at night, burning pain, distribution to spermatic cord and groin, erectile dysfunction and premature ejaculation.ConclusionsMen with chronic orchialgia have a high incidence of associated symptoms. Most bothersome symptoms with highest QOL impact include burning pain, pain at night, radiation to groin and spermatic cord, erectile dysfunction and low libido. Based on these findings, we have created a candidate orchialgia symptom index with domains of pain, sexual symptoms and QOL that will undergo prospective validation.

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“…Numerous groups have published success rates ranging from 77–100% in terms of significant reduction or elimination of pain. 18 , 21 , 22 , 47 , 62 The trifecta nerve complex mentioned in the pathophysiology section above explains the benefit of MDSC in CSP patients. Ligation of the nerves with Wallerian degeneration in the trifecta is likely to provide pain relief or reduction in CSP patients undergoing MDSC.…”

Section: Treatment Algorithm For Chronic Orchialgia or Chronic Scrotamentioning

confidence: 99%

<p>Management of Chronic Orchialgia: Challenges and Solutions – The Current Standard of Care</p>

Parekattıl¹,

Ergun²,

Güdeloğlu³

2020

RRU

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Introduction Chronic scrotal content pain (CSP) or chronic orchialgia can be debilitating for patients and difficult to treat. There is a paucity of structured treatment algorithms to approach this difficult condition. Methods A review of the literature was performed. Conservative treatment options are presented and then targeted surgical interventions that the urologist may perform are then presented in a structured algorithm format. Many of these patients may obtain a significant reduction in pain with some of these treatments. Results This review presents the pathophysiology, a new assessment tool, and various treatment options available for CSP patients, such as targeted spermatic cord blocks, targeted and standard microsurgical denervation of the spermatic cord (77–100% success rates), ultrasound-guided peri-spermatic cord and ilioinguinal cryoablation (59–75% success rates), scrotox (botox) (56–72% success rates), targeted ilioinguinal and iliohypogastric peripheral nerve stimulation (72% success rate), radical orchiectomy (20–75% success rate), targeted robotic-assisted intra-abdominal denervation (71% success rate) and vasectomy reversal (69–100% success rates). Conclusion A structured and evidence-based approach to help urologists manage patients with chronic orchialgia or scrotal content pain is presented.

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

Abstract: 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.

Cited by 31 publications

References 21 publications

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

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

Development of a clinically relevant symptom index to assess patients with chronic orchialgia/chronic scrotal content pain

<p>Management of Chronic Orchialgia: Challenges and Solutions – The Current Standard of Care</p>

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