Management of chronic testalgia by microsurgical testicular denervation.

Abstract

OBJECTIVES:

Chronic testicular pain (CTP) is defined as uni- or bilateral, intermittent or continuous testicular discomfort of at least 3 months duration that interferes with the patient's daily activities and prompts him to seek medical advice is a rather common urological manifestation of chronic pain syndrome. Diagnosis and treatment of CTP has been a difficult and often unrewarding clinical situation. Success rates of conservative and surgical measures including epididymectomy and orchiectomy rarely exceed 55-73% and 10-40%, respectively. We report our experience on microsurgical testicular denervation as therapeutic option in CTP.

PATIENTS AND METHODS:

Following an extensive preoperative work-up (urine/semen cultures, transrectal ultrasound, testicular sonography, pain and orthopedic consultation) not revealing any pathologic abnormalities and a positive response to spermatic cord block, 35 patients underwent microsurgical testicular denervation. In brief, spermatic cord was dissected, vas deferens, cremasteric muscle and testicular vessels were separated. After identification of the testicular artery by application of vasodilatating agents using magnifying loops or the operating microscope, all structures besides the testicular artery, vas deferens and 1-2 lymphatic vessels were coagulated and transsected using bipolar diathermy.

RESULTS:

After a mean follow-up of 31.5 months 34/35 (96%) patients are completely pain-free; no intra- or postoperative complications were encountered. No case of testicular atrophy or hydrocele formation was observed during postoperative follow-up.

CONCLUSIONS:

Microsurgical testicular denervation results in reliable and reproducible excellent therapeutic success rates of 96% and should be integrated in the management of CTP at an early stage. High success rates require adequate and meticulous diagnostic work-up of the patients by spermatic cord block using saline as placebo and different local anaesthetics as an initial therapeutic armentarium predicting postoperative outcome.

• Authors: Axel Heidenreich, Peter Olbert, Udo H Engelmann
• Journal: European urology (Eur Urol) Vol. 41 Issue 4 Pg. 392-7 (Apr 2002) ISSN: 0302-2838 [Print] Switzerland
• PMID: 12074809 (Publication Type: Journal Article)

Topics

• Adult
• Algorithms
• Chronic Disease
• Denervation
• Follow-Up Studies
• Humans
• Male
• Microsurgery
• Middle Aged
• Pain (etiology, surgery)
• Testicular Diseases (complications, diagnosis, surgery)
• Testis (innervation, surgery)
• Time Factors
• Urologic Surgical Procedures, Male (methods)