When conservative modalities for treating orchailgia are not effective surgical approaches are an option. However, they should not be considered as a primary treatment modality. The most common surgery performed is called a microsurgical denervation of the spermatic cord and should be performed by an expert urologic microsurgeon. Prior to this procedure a spermatic cord block is necessary. In this simple office procedure an anesthetic like lidocaine is infiltrated along the spermatic cord. Complete elimination of the patient’s pain should occur within 10 minutes. If the pain is not gone or significantly reduced, then it is unlikely that a microsurgical denervation of the spermatic cord will be effective in reducing the patient’s pain.
A microsurgical denervation of the spermatic cord is a procedure done under an anesthesia by a surgeon specially trained in the use of an operating microscope. It is sometime inappropriately referred to as “cord stripping” since the surgeon meticulously dissects tissues surrounding the spermatic cord under the operating microscope. The goal of the procedure is to leave only the vital structures of the spermatic cord (i.e. the vasal blood supply and lymphatics) while interrupting the nerves that run through the spermatic cord. The vas deferent is preferentially divided if the patient does not wish future fertility since the perivasal sheath often contains a significant complement of nerves. The procedure has been found to be very effective (i.e.,70% of patients have a significant decrease or elimination of their pain). However, significant risks exist including infection, damage to the blood supply to the testis which can result in elimination of testicular testosterone production and/or sperm production by the testis as well as possible loss of the Testis. These risks need to be throughly discussed with the patient prior to consideration of the procedure. If the patient has bilateral orchialgia only one spermatic cord should be operated on. Several months should be allowed to assure viability of the testis prior to consideration of a procedure on the other side.
Please feel free to contact Dr. Gilbert directly for questions.
Bruce R.Gilbert, M.D., Ph.D. at 516-487-2700 or info@BruceGilbertMD.com