Prevention of Orchialgia After Left-Sided Laparoscopic Donor Nephrectomy-A Prospective Study.
OBJECTIVE
Etiology of orchialgia or testicular pain after laparoscopic donor nephrectomy (LDN) has been found to be related to injury of the spermatic plexus during gonadal (testicular) vein (GV) or ureteral ligation. This study aimed to evaluate and validate the impact of the level of ligation of GV and ureter in relation to the crossing of iliac vessels (CIV) on incidence of orchialgia.


METHODS
A prospective study was conducted on 70 males who underwent left LDN from January 2008 to December 2010 (group A) to determine the correlation between orchialgia and level of ligation of the GV and ureter with respect to CIV; this revealed that the ligation of the GV and/or ureter above the level of the CIV (level 1, n=40) is less likely to cause orchialgia than ligating them at or below (level 2, n=30). Subsequently, in 45 male patients (group B) for left LDN from January 2011 to June 2013, we ensured that clipping of the ureter and GV be performed above the CIV to validate the above findings. Patients with a history of scrotal pathology or surgical procedure were excluded. One-sided Z-test with pooled variance was used to calculate the sample size.


RESULTS
In group A, orchialgia was seen in 10 (14.3%) patients. The clipping of the ureter and GV at level 2 (orchialgia, n=9) was associated with a significantly higher incidence of orchialgia than clipping them at level 1 (orchialgia, n=1) (P=0.001,95% confidence interval=0.0707 to 0.2471). In group B, 43 patients were finally analyzed, and none had orchialgia.


CONCLUSIONS
The level of ligation of the GV and ureter has significant impact on the incidence of orchialgia. Ipsilateral testicular pain in patients with left-sided LDN is preventable, if the ureter and GV are ligated or clipped above the level of iliac vessels bifurcation.
Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences , Lucknow, India .
Sanjoy Kumar
SK
Sureka
Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences , Lucknow, India .
Aneesh
A
Srivastava
Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences , Lucknow, India .
Shikhar
S
Agarwal
Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences , Lucknow, India .
Alok
A
Srivastava
Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences , Lucknow, India .
Sachin
S
An
Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences , Lucknow, India .
Sanjeet
S
Singh
Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences , Lucknow, India .
Varun
V
Mittal
Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences , Lucknow, India .
Nitesh
N
Patidar
Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences , Lucknow, India .
Rakesh
R
Kapoor
Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences , Lucknow, India .
M S
MS
Ansari
D000328:Adult; D006801:Humans; D007194:India; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods; D008026:Ligation / Q000009:adverse effects / Q000379:methods; D008297:Male; D009392:Nephrectomy / Q000009:adverse effects* / Q000379:methods; D017063:Outcome Assessment, Health Care; D010147:Pain Measurement; D010149:Postoperative Pain / Q000209:etiology* / Q000517:prevention & control; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology* / Q000517:prevention & control; D011446:Prospective Studies; D013733:Testicular Diseases / Q000209:etiology* / Q000517:prevention & control; D014019:Tissue Donors; D020858:Tissue and Organ Harvesting / Q000009:adverse effects / Q000379:methods; D014513:Ureter / Q000601:surgery*