title: Microsurgical Spermatic Cord Denervation as a Treatment for Chronic Scrotal Content Pain: A Multicenter Open Label Trial.
abstract: OBJECTIVE
  We prospectively evaluated the results of microsurgical spermatic cord denervation in a series of patients with chronic scrotal content pain in a multicenter study, including 1 center in Germany and 3 centers in Chile.
  
  
  METHODS
  A total of 50 patients with chronic scrotal content pain more than 3 months in duration were prospectively selected for standardized operative microsurgical spermatic cord denervation as pain treatment. In all patients preoperative management included a positive response to a spermatic cord block test with local anesthesia. Pain severity was assessed using an analog visual pain scale (range 0 to 10) for 30 consecutive days. A total of 52 testicular units were operated on using a subinguinal approach. In all cases a surgical microscope was used to identify the arteria testicularis.
  
  
  RESULTS
  No intraoperative complications were observed and no testicular units were lost. Two reoperations were performed, including 1 for hematocele and 1 for hydrocele. Six months after surgery 40 patients (80%) were completely pain-free. In 6 patients (12%) intermittent testicular discomfort persisted, which could be managed by acetaminophen on demand. Four patients (8%) had no change in pain severity after surgery.
  
  
  CONCLUSIONS
  After proper selection of patients microsurgical spermatic cord denervation seems to be a safe and efficient procedure to treat chronic scrotal content pain. Considering the limitations of the study, a randomized, controlled trial with longer followup is highly warranted.
authors.affiliation: Department of Urology, Pontificia Universidad Católica de Chile, Santiago, Chile. Electronic address: mmarconi@andro.cl.
authors.forename: Marcelo
authors.initials: M
authors.lastname: Marconi
authors.affiliation: Department of Urology, Hospital Clínico Universidad de Chile, Santiago, Chile; Department of Urology, Clinica Las Condes, Santiago, Chile.
authors.forename: Cristian
authors.initials: C
authors.lastname: Palma
authors.affiliation: Department of Urology, Pontificia Universidad Católica de Chile, Santiago, Chile.
authors.forename: Pablo
authors.initials: P
authors.lastname: Troncoso
authors.affiliation: Department of Urology, Pontificia Universidad Católica de Chile, Santiago, Chile.
authors.forename: Arturo
authors.initials: A
authors.lastname: Dell Oro
authors.affiliation: Department of Urology, Pediatric Urology and Andrology, University Clinic of Giessen, Giessen, Germany.
authors.forename: Thorsten
authors.initials: T
authors.lastname: Diemer
authors.affiliation: Department of Urology, Pediatric Urology and Andrology, University Clinic of Giessen, Giessen, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Weidner
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D059350:Chronic Pain / Q000175:diagnosis / Q000601:surgery*; D003714:Denervation / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D011446:Prospective Studies; D012611:Scrotum / Q000294:innervation; D012720:Severity of Illness Index; D013085:Spermatic Cord / Q000294:innervation*; D016896:Treatment Outcome; D055815:Young Adult
keywords: chronic pain; denervation; scrotum; spermatic cord; testis