Microsurgical denervation of the spermatic cord with tunica vaginalis fenestration: results of a case series with a review of the literature

Abstract Microsurgical denervation of the spermatic cord (MDSC) is one of the lines of management of chronic orchialgia, but it has not been fully adopted by different centers. This article reviews a case series experience with a review of the literature. Eighteen patients (18 testicular units) with chronic orchialgia, unresponsive to medical treatment were prospectively enrolled in this study. All underwent unilateral MDSC with a slight modification in the technique (tunica vaginalis fenestration). Efficacy of the technique was evaluated by the degree of pain improvement using the Visual Analogue Scale (VAS) which was done preoperatively and 6 months postoperatively. Safety was assessed by reporting any intra- or post-operative complications. Available literature was reviewed looking at safety and efficacy of the technique. Six patients had complete pain resolution, 11 had partial but significant resolution of their pain and the pain remained the same in one patient following MDSC. The VAS pain score significantly improved from a median (IQR) of 8(7.25-9) to 2(2-4.75) postoperatively (p=0.0029). No significant complications have been encountered in this study. So, MDSC seems to be a safe and efficacious surgical option for the treatment of resistant chronic scrotal pain (CSP) and should be more widely adopted by specialized centers.