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Microsurgical denervation of the spermatic cord (MDSC) can provide up to an 86% improvement in pain in patients with chronic orchialgia (CO) who have failed conservative management. Failures in MDSC could be due to small diameter nerves (≤1 mm) left behind on the spermatic cord. The objective of this study was to assess if hydrodissection (HD) of t...
Similar publications
Microsurgical denervation of the spermatic cord (MDSC) is a treatment option in patients with chronic orchialgia. This procedure requires precise care to avoid any thermal damage to crucial adjacent tissues (arteries, veins, and lymphatics). Monopolar electrocautery is the standard ligation energy source, but may cause extensive collateral damage t...
Citations
... This showed that the use of hydrodissection significantly decreases residual nerve density without compromising vascular integrity in a rat model. 27 While there does not seem to a true "golden standard" treatment for CSP, one may argue that hydrodissection could be an interesting method with future potential. Orchiectomy As a last resort for cases of CSP that are resistant to virtually all other treatment options, one may consider an orchiectomy. ...
Introduction
Chronic scrotal pain (CSP) can be a debilitating condition for patients and is often difficult to characterize.
Methods
A review of literature was performed using Embase, Cochrane and Medline databases in the period 1.January 2010 to 1.January 2021. We found 132 articles, and the authors screened abstract and references. Thirty-seven articles are included after removing duplicates.
Results
This review presents a variety of medical and surgical treatment options for CSP such as spermatic cord blocks (36–80% success rate), microsurgical denervation of the spermatic cord (76–100% success rates), Botox (56% success rate), targeted ilioinguinal and iliohypogastric peripheral nerve stimulation, and radical orchiectomy (55–75% success rate).
Conclusion
An overview of various treatment options, both non-surgical and surgical are provided, with the aim of establishing what may be the best treatment option for CSP.
Microsurgery has long been a challenging field for surgeons. Many attempts have been made to ameliorate this technique. One of the most remarkable advancements in this field was made by robotic platforms. Absent tremor, improved precision, increased optical magnification, and optimizable instrumentation are the primary advantages of these platforms. On the other hand, maintenance and overall cost still appear to be limiting factors. In this chapter, we covered novel advancements in robotic microsurgery and existing technologies that are available for a more convenient microsurgical experience.
Introduction
The management of chronic scrotal pain is long and varied, with historical treatment algorithms typically ending with orchiectomy. Microsurgical denervation of the spermatic cord (MDSC) is a testicle-sparing option for patients who have failed conservative treatment options and over its forty-year history has seen many technical refinements.
Objectives
To review the history and development of MDSC and discuss the outcomes of different surgical techniques.
Methods
A literature review using PubMed and Google Scholar was conducted to identify studies pertaining to surgical treatment of CSP, MDSC, and outcomes. Search terms included “chronic,” “scrotal pain,” “orchialgia,” “spermatic cord,” “denervation,” and “microsurgery.”
Results
We included 21 case reports and series since the first seminal paper describing MDSC technique in 1978. Additional studies that challenged existing conventions or described novel techniques are also discussed. The current standard procedure utilizes a subinguinal incision and a surgical microscope. Open, robotic, and laparoscopic approaches to MDSC have been described, but access to minimally invasive instruments may be limited outside of developed nations. Pain reduction following preoperative spermatic cord predicts success of MDSC. Methods for identifying and preserving the testicular and deferential arteries vary depending on surgeon preference but appear to have comparable outcomes. Future developments in MDSC involve targeted denervation, minimizing collateral thermal injury, and alternative techniques to visualize arterial supply.
Conclusion
For patients suffering from CSP, MDSC is a well-studied technique that may offer appropriately selected patients’ relief. Future investigation comparing targeted vs full MDSC as well as in vivo study of new techniques are needed to continue to improve outcomes.
