EFFICACY OF TARGETED VS STANDARD SPERMATIC CORD DENERVATION IN THE MANAGEMENT OF CHRONIC ORCHIALGIA: A COMPARATIVE STUDY
DOI:
https://doi.org/10.71000/jehtqa48Keywords:
Chronic Orchialgia, Denervation, Microsurgery, Pain Management, Spermatic Cord, Surgical Treatment, Testicular PainAbstract
Background: Chronic orchialgia, defined as testicular or scrotal pain persisting for more than three months, remains a challenging condition to treat, often leading to significant impairment in quality of life. While conservative management including pharmacotherapy and nerve blocks offers initial relief, many patients experience persistent symptoms requiring surgical intervention. Microsurgical spermatic cord denervation (MSCD) has emerged as an effective technique; however, the comparative efficacy of targeted versus complete MSCD remains inadequately explored.
Objective: To evaluate and compare the clinical outcomes of targeted versus complete spermatic cord denervation in patients with chronic orchialgia unresponsive to conservative treatment.
Methods: This comparative study was conducted over two years at a tertiary care hospital and included 50 male patients aged 18–55 years with chronic orchialgia lasting more than three months. After diagnosis confirmation via clinical evaluation and spermatic cord block using 5 mL of 1% lidocaine with 40 mg triamcinolone, patients were randomly allocated into two equal groups. Group A (n=25) underwent complete MSCD involving skeletonization of the spermatic cord, while Group B (n=25) underwent targeted MSCD focusing on the cremasteric muscle, peri-vasal sheath, and posterior lipomatous tissues. Pain outcomes were assessed using the Visual Analog Scale (VAS) at baseline and 6-month follow-up.
Results: In the complete denervation group, 19 patients (76%) experienced complete pain resolution, 2 (8%) had partial relief, and 4 (16%) showed no improvement. In the targeted group, 18 patients (72%) achieved complete resolution, 1 (4%) had partial relief, and 6 (24%) reported no improvement. Statistical analysis revealed no significant difference between groups (p > 0.05).
Conclusion: Both targeted and complete MSCD are effective for treating chronic orchialgia. Given its less invasive nature, targeted denervation may be a suitable alternative in appropriately selected patients.
References
Panunzio A, Tafuri A, Mazzucato G, Cerrato C, Orlando R, Pagliarulo V, et al. Botulinum Toxin-A Injection in Chronic Pelvic Pain Syndrome Treatment: A Systematic Review and Pooled Meta-Analysis. Toxins (Basel). 2022;14(1).
Lam J, Solsrud E, Hart A, Moore A, Pearlman A. Characterizing patients with chronic scrotal content pain: a retrospective review of clinical presentations. Ther Adv Urol. 2025;17:17562872251348009.
Oh PJ, Bajic P, Lundy SD, Ziegelmann M, Levine LA. Chronic Scrotal Content Pain: a Review of the Literature and Management Schemes. Curr Urol Rep. 2021;22(2):12.
Campbell K, Lipshultz L. Current trends and therapies in orchialgia management. Ther Adv Urol. 2021;13:17562872211026433.
Qin KR, Qu LG. Diagnosing with a TWIST: Systematic Review and Meta-Analysis of a Testicular Torsion Risk Score. J Urol. 2022;208(1):62-70.
Hisamatsu E. Editorial Comment to Nomogram predicting testicular torsion in Japanese patients with acute scrotal pain using physical examination findings and environmental conditions: Development and prospective external validation. Int J Urol. 2022;29(1):49.
Kangwa M, Li Y, Tejwani NA, Copp HL, Naprawa J. Emergency department management of acute scrotal pain in pediatric patients. Pediatr Emerg Med Pract. 2024;21(10):1-24.
Lacy A, Smith A, Koyfman A, Long B. High risk and low prevalence diseases: Testicular torsion. Am J Emerg Med. 2023;66:98-104.
Rutigliani L, Agrawal P, Herati AS. The impact of subcentimeter cysts on chronic scrotal pain. Asian J Androl. 2023;25(6):750-2.
Alzahrani MA, Alasmari MM, Altokhais MI, Alkeraithe FW, Alghamdi TA, Aldaham AS, et al. Is There a Relationship Between Waking Up from Sleep and the Onset of Testicular Torsion? Res Rep Urol. 2023;15:91-8.
Parsons BA, Baranowski AP, Berghmans B, Borovicka J, Cottrell AM, Dinis-Oliveira P, et al. Management of chronic primary pelvic pain syndromes. BJU Int. 2022;129(5):572-81.
Sun HH, Tay KS, Jesse E, Muncey W, Loeb A, Thirumavalavan N. Microsurgical Denervation of the Spermatic Cord: A Historical Perspective and Recent Developments. Sex Med Rev. 2022;10(4):791-9.
Zhanghuang C, Wang J, Hang Y, Ji F, Yao Z, Mao R, et al. A novel nomogram to predict testicular torsion in children with acute scrotal pain: a single-center retrospective study in western China. Transl Androl Urol. 2024;13(5):776-91.
Alzahrani MA, Safar O, Almurayyi M, Alahmadi A, Alahmadi AM, Aljohani M, et al. Pulsed Radiofrequency Ablation for Orchialgia-A Literature Review. Diagnostics (Basel). 2022;12(12).
Ergun O, Gudeloglu A, Parekattil SJ. Robotic Surgery for Male Infertility and Chronic Scrotal Content Pain. J Endourol. 2022;36(S2):S48-s60.
Lai CZ, Chen SJ, Huang CP, Chen HY, Tsai MY, Liu PL, et al. Scrotal Pain after Varicocelectomy: A Narrative Review. Biomedicines. 2023;11(4).
Kravchick S, Parekattil SJ, Bratslavsky G, Beamer MR, Moldwin R, Shulman D, et al. A simplified treatment algorithm for chronic scrotal content pain syndrome. Curr Urol. 2024;18(4):251-6.
Visser WR, Smith-Harrison L, Payne B, Smith RP, Krzastek SC. Surgical management of chronic scrotal pain: a review of the current literature. Minerva Urol Nephrol. 2022;74(5):551-8.
Muraliharan JS, Jacob TJK, Bollu BK, Graf N, Sebastian T, Thomas G. Surgical management of the acute paediatric scrotum: a three-year single centre experience. ANZ J Surg. 2021;91(11):2514-7.
Parekattil SJ. Targeted Microsurgical Denervation of the Spermatic Cord for Chronic Orchialgia: the Current Standard of Care. Curr Urol Rep. 2020;21(11):47.
Laher A, Ragavan S, Mehta P, Adam A. Testicular Torsion in the Emergency Room: A Review of Detection and Management Strategies. Open Access Emerg Med. 2020;12:237-46.
Patel, V. M., et al. (2020). Outcomes of microsurgical spermatic cord denervation for chronic orchialgia: a single-institution experience. Urology, 139, 157-162.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Mir abid jan, Naveed Ahmad Khan, Khalil Ur Rehman, Spogmai (Author)
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
