Spermatic cord denervation

[dshoskes]

Not a purely chronic prostatitis / chronic pelvic pain syndrome issue, but I have begun to do the microscopic spermatic cord denervation operation for chronic orchialgia (scrotal or testicular pain). Many chronic prostatitis / chronic pelvic pain syndrome patients have orchialgia which often improves with appropriate treatment but some have persistent orchialgia despite resolution of other symptoms and in others orchialgia is their only symptom (it is debatable whether that represents true CPPS; by definition it can but isolated orchialgia has been an exclusion criteria for most clinical trials due to the belief it may be a separate condition). Based on the published results of others who have been doing this operation for a long time I am limiting it to patients with pain greater than 6 months unresponsive to other standard treatments (including PT if they have pelvic floor spasm) and complete temporary resolution of the pain following injection of local anesthetic into the spermatic cord. It's done through a 1-2 inch incision just above the scrotum over the pubic bone using general anesthesia and the patient goes home the same day. Published results suggest 80% with total or significant improvement long term and so far short term all my patients are better (although I expect my results to regress to the mean). I'm not a "true believer" yet by any means and will be tracking my results closely but for properly selected patients it seems to be a useful tool.

Daniel Shoskes MD
http://www.dshoskes.com

[Jay]

Hi Dr. Shoskes,

It is good to see you posting again. Word from you is always welcome!

I've heard of this procedure before, but I'm not certain as to the success rate among those who said they'd had it. Just anecdotal stuff. Please let us know how this treatment holds up as time goes on.

Would I be correct in assuming that this procedure is reserved for patients only suffering from orchialgia? In other words, you might not perform it if they have additional chronic prostatitis / chronic pelvic pain syndrome symptoms at the time?

[dshoskes]

It really depends. If there were other chronic prostatitis / chronic pelvic pain syndrome symptoms due to neurologic or pelvic muscle causes, I would want to see the results of therapy first, but if the orchialgia is a separate problem and most importantly, if an anesthetic cord block eliminates the pain, then the operation would be worth doing.

Hi Dr. Shoskes,

It is good to see you posting again. Word from you is always welcome!

I've heard of this procedure before, but I'm not certain as to the success rate among those who said they'd had it. Just anecdotal stuff. Please let us know how this treatment holds up as time goes on.

Would I be correct in assuming that this procedure is reserved for patients only suffering from orchialgia? In other words, you might not perform it if they have additional chronic prostatitis / chronic pelvic pain syndrome symptoms at the time?

[benzo]

It really depends. If there were other chronic prostatitis / chronic pelvic pain syndrome symptoms due to neurologic or pelvic muscle causes, I would want to see the results of therapy first, but if the orchialgia is a separate problem and most importantly, if an anesthetic cord block eliminates the pain, then the operation would be worth doing.

Dr Shoskes, what do you consider a 'separate problem'? Suppose you have typical chronic prostatitis / chronic pelvic pain syndrome symptoms in addition to testicular pain, such as intermittent rectal pain, pubic pain, perineum pain etc, would that automatically rule you out as a candidate for the surgery?

I find this topic interesting because about 9 years ago, I went to Germany (University Hospital of Cologne) where they performed the surgery at the time. I saw Dr. Frank Sommer (http://www.maennergesundheit.info/biography.html) who injected the cord block twice. I only had partial pain relief, mainly in the suprapubic region. However, it did very little for the testicular discomfort which led me to believe that it was mainly referred pain. Dr. Sommer advised against the surgery, mainly because of the lack of previous trauma.

The majority of the patients he operated on were people who underwent a vasectomy. Previously, I purchased a copy of The Journal of Urology (http://www.jurology.com/article/S0022-5 ... 9/abstract) which contained a small study where the majority of the participants also had vasectomies.

Looking forward to your reply.

[dshoskes]

The greater the pain relief with cord block and the fewer the other sites of pain, the more likely the operation would be to help the scrotal pain (there is NO expectation that the surgery would help pain or symptoms anywhere else).

[dshoskes]

After some initial delays in getting started, I have now done the operation 9 times in 8 patients (1 bilateral). 2 patients did not improve, 7 are pain free (actually 6 patients pain free, 1 patient pain free on both sides). So far no surgical complications. Definitely seems to have a role for this very debilitating problem.