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Microdenervation of the spermatic cord for post‐vasectomy pain syndrome
Author(s) -
Tan Wei Phin,
Tsambarlis Peter N.,
Levine Laurence A.
Publication year - 2018
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.14125
Subject(s) - medicine , spermatic cord , surgery , vasectomy , scrotal pain , quartile , scrotum , anesthesia , population , research methodology , confidence interval , environmental health , family planning
Objective To evaluate the outcomes of patients who underwent microdenervation of the spermatic cord ( MDSC ) for post‐vasectomy pain syndrome ( PVPS ) at our institution. Methods A retrospective study of all patients who underwent MDSC for PVPS by a single surgeon between March 2002 and October 2016 was performed. Pain was documented using the numerical rating scale ( NRS ). Spermatic cord block ( SCB ) was performed on all patients, and success was defined as NRS score ≤1 for >4 h. All patients had failed medical therapy prior to MDSC . All previous procedures for PVPS had been performed elsewhere. Surgical success was defined as a postoperative NRS score of ≤1. Results A total of 27 patients with 28 scrotal units underwent MDSC for PVPS . The median (1st quartile; 3rd quartile) follow‐up was 10 (2; 16.5) months. The median (range) duration of pain prior to surgery was 57 (8–468) months. Pain was bilateral in 14 (52%), left‐sided in eight (30%) and right‐sided in five patients (19%). Data on SCB were available for 23 patients, with a success rate of 96%. The median (range) preoperative pain NRS score was 7 (2–10). The median (range) pain score after SCB on the NRS scale was 0 (0–5). The median (range) postoperative pain score on the NRS was 0 (0–9). Overall success was achieved in 20 of 28 testicular units (71%). Patients with involvement of multiple structures in the scrotum (i.e. testis, epididymis, spermatic cord) had a success rate of 81% and were more likely to have a successful surgery ( P < 0.001). Five patients had failed a prior epididymectomy and three had failed a vaso‐vasostomy for PVPS ; this had no correlation with the success of MDSC ( P = 0.89). Conclusion The MDSC procedure is a reasonably successful, durable and valuable approach for PVPS , especially when pain involves multiple structures in the scrotum (testis, epididymis, spermatic cord). MDSC was equally efficacious in patients who had previously failed a procedure for PVPS . No patient had a worsening NRS score after MDSC . This is the largest study to date evaluating MDSC for the treatment of PVPS .