Microvascular Doppler Assisted Microsurgical Denervation of the Spermatic Cord in Treating Chronic Orchialgia

Summary

Here, we present a protocol to treat chronic orchialgia by microsurgical denervation of the spermatic cord. Combined with the use of a microvascular doppler, the procedures can be more easily implemented.

Abstract

Chronic orchialgia is a common disease in department of urology and andrology. The etiology is complex, and the treatment is difficult. In severe cases, orchiectomy is even necessary. In recent years, microsurgical denervation of the spermatic cord (MDSC) is a minimally invasive and effective surgical method for the treatment of chronic orchialgia. Its greatest advantage is to preserve the testis and epididymis, avoid the possible organ resection. The key of the operation is to dissect all the fibrous tissues in the spermatic cord, while protecting the arteries (especially the testicular arteries) and several lymphatic vessels. Combined with the use of microvascular doppler in the operation, when separating the structure of spermatic cord under the microscope, the testicular arteries can be objectively and accurately protected (pulse “whistle” sound can be heard when the microvascular doppler probes the arterial surface), while artery injury and venous missed ligation can be avoided. The postoperative blood supply of the testis is also maximumly safeguarded. At the same time, we can be more fearless to cut the cremaster muscle, fatty and connective tissues surrounding the spermatic cord blood vessels and vas deferens after the arteries and lymphatic vessels being accurately protected under the microscope, finally achieve the spermatic cord completely "skeletonized" (only the testicular arteries, lymphatic vessels and vas deferens remained after the surgery). Thus we can better ensure the clinical curative effect (denervation thoroughly), avoid serious complications (testicular atrophy), and achieve better surgical results.

Introduction

Chronic orchialgia is a common disease accounting for about 2.5%–4.8% of all urology clinic visits¹, which has been defined as more than 3 months of unilateral or bilateral scrotal pain interfering with daily life that ultimately leads to the pursuit of treatment^2,3. The etiology is complex, and up to 50% of patients have no obvious etiology⁴. The exact mechanism is still unclear. Wallerian degeneration in peripheral nerves has been shown to be a potential cause of chronic pain^5,6.

Protocol

The protocol was conducted in accordance with the Declaration of Helsinki, and the protocol was approved by the ethics committee of the First Affiliated Hospital of Sun Yat-sen University. Chronic orchialgia patients who failed conservative treatment were admitted and signed informed consent.

1. Instruments for operation

1. Ensure the availability of the surgical microscope and microvascular doppler.

2. Preparation

Discussion

Microsurgical denervation of the spermatic cord (MDSC) is a minimally invasive surgical option for treating chronic orchialgia after the failure of conservative treatments^7,8. Significant reduction or elimination of pain is reported in various studies; the pain relief rate is about 80%^4,10,11. Prior to MDSC, it is recommended that the patient undergo a spermatic cord blo.......

Materials

Name	Company	Catalog Number	Comments
Surgical microscope	Leica	Model M520 MC-1	Leica operating microscope
Micro needle forceps	Cheng-He,NingBo	HC-A006	microsurgery instrument
Micro scissors	Cheng-He,NingBo	HC-A008	microsurgery instrument
Microscopic tweezers	Cheng-He,NingBo	HC-A002	microsurgery instrument
Microvascular doppler	VTI	VTI 20 MHz	intra-operative vascular Doppler flow detector