Skip to main content
SpringerLink
Log in

Spermatic Cord Denervation for Chronic Orchialgia

  • Male and Female Surgical Interventions (A Burnett and C Carson, Section Editors)
  • Published:
Current Sexual Health Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

To review the surgical management of chronic scrotal content pain with microsurgical spermatic cord denervation (MSCD).

Recent Findings

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.

Summary

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Gray C, Powell C, Amling C. Outcomes for surgical management of orchialgia in patients with identifiable intrascrotal lesions. Eur Urol. 2001;39(4):455–9.

    Article  CAS  Google Scholar 

  2. Padmore D, Norman R, Millard O. Analyses of indications for and outcomes of epididymectomy. J Urol. 1996;156(1):95–6.

    Article  CAS  Google Scholar 

  3. • Parekattil S, Gudeloglu A, Brahmbhatt J, Priola K, Vieweg J, Allan R. Trifecta nerve complex: potential anatomical basis for microsurgical denervation of the spermatic cord for chronic orchialgia. J Urol. 2013;190(1):265–70 This is an important study explaining the anatomic basis for MSCD.

    Article  Google Scholar 

  4. Marconi M, Palma C, Troncoso P, Dell Oro A, Diemer T, Weidner W. Microsurgical spermatic cord denervation as a treatment for chronic scrotal content pain: a multicenter open label trial. J Urol. 2015;194:1323–7. https://doi.org/10.1016/j.juro.2015.05.081.

    Article  PubMed  Google Scholar 

  5. • Tatem A, Kovac JR. Chronic scrotal pain and microsurgical spermatic cord denervation: tricks of the trade. Transl Androl Urol. 2017;6(S1):S30–6. https://doi.org/10.21037/tau.2017.05.17 This is an excellent review on the procedure including a useful algorithm for chronic orchialgia.

    Article  PubMed  PubMed Central  Google Scholar 

  6. •• Devine C, Schellhammer P. The use of microsurgical denervation of the spermatic cord for orchialgia. Trans Am Assoc Genitourin Surg. 1978;70:149–51 This study is the original description of MCSD.

    PubMed  Google Scholar 

  7. Levine LA, Matkov TG, Lubenow TR. Microsurgical denervation of the spermatic cord: a surgical alternative in the treatment of chronic orchialgia. J Urol. 1996;155:1005–7. https://doi.org/10.1016/S0022-5347(01)66369-9.

    Article  CAS  PubMed  Google Scholar 

  8. Choa RG, Swami KS. Testicular denervation. A new surgical procedure for intractable testicular pain. Br Journaloj Urol Br J Urol. 1992;70:417–9.

    Article  CAS  Google Scholar 

  9. Heidenreich A, Olbert P, Engelmann UH. Management of chronic testalgia by microsurgical testicular denervation. Eur Urol. 2002;41(4):392–7. https://doi.org/10.1016/S0302-2838(02)00023-4.

    Article  PubMed  Google Scholar 

  10. Oomen R, Witjens A, van Wijck A, Grobbee D, Lock T. Prospective double-blind preoperative pain clinic screening before microsurgical denervation of the spermatic cord in patients with testicular pain syndrome. Pain. 2014;155(9):1720–6.

    Article  Google Scholar 

  11. Strom K, Levine L. Microsurgical denervation of the spermatic cord for chronic orchialgia: long-term results from a single center. J Urol. 2008;180(3):949–53.

    Article  Google Scholar 

  12. Tan WP, Levine LA. What can we do for chronic scrotal content pain? World J Mens Health. 2017;35(3):146–155.

    Article  Google Scholar 

  13. •• Jarvi K, Wu C, Nickel JC, Domes T, Grantmyre J, Zini A. Canadian Urological Association best practice report on chronic scrotal pain. Can Urol Assoc J. 2018;1212(6):161–72. https://doi.org/10.5489/cuaj.5238 These are the only society supported guidelines available for clinicians on chronic orchialgia.

    Article  Google Scholar 

  14. Parekattil S, Cohen M. Robotic surgery in male infertility and chronic orchialgia. Curr Opin Urol. 2010;20(1):75–90.

    Article  Google Scholar 

  15. Parekattil S, Gudeloglu A. Robotic assisted andrological surgery. Asian J Androl. 2013;15(1):67–74.

    Article  Google Scholar 

  16. • Polackwich A, Arora H, Li J, Sijo P, Shoskes D. Development of a clinically relevant symptom index to assess patients with chronic orchialgia. J Urol. 2016;195(4):e455. https://doi.org/10.21037/tau.2018.04.10 A validation of a symptom index for chronic orchialgia which can be used in future studies to standardize pain assessment.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Urology, Glickman Urologic and Kidney Institute, Cleveland Clinic Foundation, 9500 Euclid Ave Q-10, Cleveland, OH, USA

    Sarah C. Vij & Daniel A. Shoskes

Authors
  1. Sarah C. Vij
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Daniel A. Shoskes
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Daniel A. Shoskes.

Ethics declarations

Conflict of Interest

Sarah C. Vij declares no potential conflicts of interest.

Daniel A. Shoskes reports personal fees from Farr Labs and Aquinox.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Male and Female Surgical Interventions

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Vij, S.C., Shoskes, D.A. Spermatic Cord Denervation for Chronic Orchialgia. Curr Sex Health Rep 10, 329–332 (2018). https://doi.org/10.1007/s11930-018-0178-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11930-018-0178-x

Keywords

Search

Navigation