title: Prospective double-blind preoperative pain clinic screening before microsurgical denervation of the spermatic cord in patients with testicular pain syndrome.
abstract: Testicular pain syndrome (TPS), defined as an intermittent or constant pain in one or both testicles for at least 3 months, resulting in significant reduction of daily activities, is common. Microsurgical denervation of the spermatic cord (MDSC) has been suggested as an effective treatment option. The study population comprised 180 TPS patients admitted to our outpatient urology clinic between 1999 and 2011. On 3 different occasions, patients were offered a double-blind, placebo-controlled temporary blockade of the spermatic cord. A single blockade consisted of 10 mL 2% lidocaine, 10 mL 0.25% bupivacaine, or 10 mL 0.9% sodium chloride. If the results of these blockades were positive, MDSC was offered. All MDSCs were performed by a single urologist (M.T.W.T.L.) using an inguinal approach. Pain reduction was determined at prospective follow-up. This study evaluated 180 patients. Most patients (61.1%) had undergone a scrotal or inguinal procedure. Patients had complaints during sexual activities (51.7%), sitting (37.5%), and/or cycling (36.7%); 189 randomized blockades were offered to all patients. There was a positive response in 37% and a negative response in 51%. MDSC was performed on 58 testicular units, including 3 patients with a negative outcome of the blockades. At mean follow-up of 42.8 months, 86.2% had a ≥ 50% reduction of pain and 51.7% were completely pain free. MDSC is a valuable treatment option for TPS patients because in this study 86.2% experienced a ≥ 50% reduction of pain. To prevent superfluous diagnostics and treatment, it is mandatory to follow a systematic protocol in the treatment of TPS.
authors.affiliation: Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands Department of Urology, Central Military Hospital, Utrecht, The Netherlands Department of Urology, Radboud University Nijmegen Medical Center, Utrecht, The Netherlands Pain Clinic, University Medical Center Utrecht, Utrecht, The Netherlands Department of Anesthesiology, University Medical Center Utrecht, Utrecht, The Netherlands Clinical Epidemiology, University Medical Center Utrecht, Utrecht, The Netherlands Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands.
authors.forename: Robert J A
authors.initials: RJA
authors.lastname: Oomen
authors.forename: Annemijke C
authors.initials: AC
authors.lastname: Witjens
authors.forename: Albert J M
authors.initials: AJM
authors.lastname: van Wijck
authors.forename: Diederik E
authors.initials: DE
authors.lastname: Grobbee
authors.forename: Tycho M T W
authors.initials: TMTW
authors.lastname: Lock
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000779:Anesthetics, Local / Q000494:pharmacology / Q000627:therapeutic use; D002045:Bupivacaine / Q000494:pharmacology / Q000627:therapeutic use; D003714:Denervation / Q000379:methods*; D004311:Double-Blind Method; D006801:Humans; D008012:Lidocaine / Q000494:pharmacology / Q000627:therapeutic use; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D010146:Pain / Q000188:drug therapy* / Q000601:surgery; D011446:Prospective Studies; D013085:Spermatic Cord / Q000187:drug effects* / Q000601:surgery; D013733:Testicular Diseases / Q000188:drug therapy* / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000779:Anesthetics, Local; D008012:Lidocaine; D002045:Bupivacaine
keywords: CO; Chronic orchialgia; Denervation; Funiculolysis; Groin pain; MDSC; Microsurgical; Randomized inguinal blockades; Scrotal content pain; Scrotal pain; Spermatic cord block; TPS; Testicular pain; Testicular pain syndrome