Microsurgical denervation of the spermatic cord as primary surgical treatment of chronic orchialgia.

Purpose: We evaluate the effectiveness of microsurgical denervation of the spermatic cord for treatment of chronic orchialgia.

Materials And Methods: Patients referred to our clinic diagnosed with chronic orchialgia are evaluated with a thorough medical and psychiatric history, physical examination and scrotal ultrasound when indicated. A total of 27 patients with chronic orchialgia refractory to nonsurgical management who had temporary pain relief after undergoing outpatient cord block were candidates for denervation. There were 6 patients who had bilateral pain, therefore, 33 testicular units were denervated. Followup ranged from 1 to 74 months (mean 20).

Results: Complete pain relief was noted in 25 (76%) testicular units, partial relief in 3 (9.1%) and no relief in the remaining 5 (15%), with a mean followup of 19, 24 and 10 months, respectively. There was no significant difference in outcome when evaluated by the etiology of orchialgia.

Conclusions: When conservative treatment fails, microsurgical denervation of the spermatic cord should be considered first rate surgical therapy for patients with chronic orchialgia.