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. 2025 Apr 30;14(4):1015-1024.
doi: 10.21037/tau-2024-719. Epub 2025 Apr 21.

Efficacy of microsurgical denervation of the spermatic cord in patients with chronic scrotal pain following unsuccessful varicocelectomy

Le Anh Tuan  1   2 , Mai Ba Tien Dung  2 , Le Dinh Hieu  1 , Vu Le Chuyen  3 , Viet Nhat Tan Mai  2 , Adnan El-Achkar  4 , Muhammed A Moukhtar Hammad  5 , Tuan Thanh Nguyen  6
Affiliations

Efficacy of microsurgical denervation of the spermatic cord in patients with chronic scrotal pain following unsuccessful varicocelectomy

Le Anh Tuan et al. Transl Androl Urol. .

Abstract

Background: Chronic scrotal pain (CSP) frequently persists following varicocelectomy, significantly impacting patients' quality of life and posing considerable therapeutic challenges. Recently, microsurgical denervation of the spermatic cord (MDSC) has emerged as a promising surgical alternative for managing CSP refractory to conventional varicocelectomy. This study evaluates the efficacy of MDSC as a treatment for CSP in patients who did not achieve symptomatic relief after varicocelectomy.

Methods: From March 2021 to March 2023, we conducted a retrospective cohort study of 45 male patients aged ≥18 years with persistent CSP following varicocelectomy. Inclusion criteria included patients unresponsive for more than three months post-varicocelectomy to medical treatments, including nonsteroidal anti-inflammatory drugs (NSAIDs), antidepressants, and anticonvulsants, and who demonstrated significant pain reduction following a spermatic cord block (SCB). Pain was assessed using the Numeric Rating Scale (NRS), a self-reported tool ranging from 0 to 10. All patients underwent MDSC based on their positive response to SCB.

Results: The average follow-up period was 14.0 months. Participants experienced significant pain reduction, with mean NRS pain scores decreasing from 7.5 pre-treatment to 1.7 following the SCB, and slightly rising to 1.8 post-operation. Significant pain relief, defined as a reduction of more than 50% in NRS score, was observed in 84.4% of cases. Minimal complications were reported, including one instance of surgical site infection, one case of postoperative bleeding, and two occurrences of numbness and burning sensations.

Conclusions: MDSC is a safe and effective option for the management of CSP in patients unresponsive to varicocelectomy, providing substantial pain relief with minimal complications.

Keywords: Microsurgical denervation of the spermatic cord (MDSC); chronic scrotal pain (CSP); varicocelectomy.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://tau.amegroups.com/article/view/10.21037/tau-2024-719/coif). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Treatment algorithm for patients with chronic scrotal pain following unsuccessful varicocelectomy. Patients are initially evaluated to exclude alternative etiologies (infection, ischemia, or malignancy). In cases where varicocele is confirmed, varicocelectomy is performed. If pain persists, a 3-month course of conservative management including scrotal support, NSAIDs, tricyclic antidepressants, and gabapentin is initiated. Patients who remain symptomatic despite these measures are subsequently considered for MDSC. MDSC, microsurgical denervation of the spermatic cord; NSAIDs, non-steroidal anti-inflammatory drugs.
Figure 2
Figure 2
Microsurgical denervation of the spermatic cord. (a) Cremasteric artery; (b) vas deferens; (c) internal spermatic artery; (d) lymphatic vessel.
See this image and copyright information in PMC

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