3 years ago

Microdenervation of the Spermatic Cord for Post Vasectomy Pain Syndrome

Laurence A. Levine, Peter N. Tsambarlis, Wei Phin Tan
Introduction Post Vasectomy Pain Syndrome (PVPS) is an uncommon urologic problem that remains a challenge to manage. We aim to evaluate the outcomes of patients who underwent microdenervation of the spermatic cord (MDSC) for PVPS at our institution. Methods A retrospective study of all patients who underwent MDSC for PVPS by a single surgeon from March 2002 to October 2016 was performed. Pain was documented using the numerical rating scale (NRS). Spermatic cord block (SCB) was performed on all patients and success was defined as NRS ≤1 for >4 hours. All patients failed medical therapy prior to MDSC. All prior procedures for PVPS were performed elsewhere. Surgical success was defined as postoperative NRS of ≤1. Results 27 patients with 28 scrotal units underwent MDSC for PVPS. Median follow up was 10 months (1st quartile 2 months, 3rd quartile 16.5 months). Median duration of pain prior to surgery was 57 months (range 8-468 months). Pain was bilateral in 14 (52%), left in 8 (30%) and right in 5 (19%) patients. Data on SCB was available for 23 patients with a success rate of 96%. Median preoperative pain on NRS score was 7 (range 2-10). Median pain following SCB on NRS scale was 0 (range 0-5). Median postoperative pain score on NRS scale was 0 (range 0-9). Success was obtained in 71% of patients, and patients with involvement of multiple structures in the scrotum (ie: testis, epididymis, spermatic cord) were more likely to have a successful surgery, p<0.001. 5 patients failed a prior epididymectomy and 3 patients failed a vaso-vasostomy for PVPS and this had no correlation with the success of MDSC, p=0.89. Conclusion MDSC is a reasonably successful, durable, and valuable approach for PVPS especially when pain involves multiple structures in the scrotum (ie: testis, epididymis, spermatic cord). MDSC is equally efficacious on patients who had previously failed a procedure for PVPS. No patient had a worsening NRS following MDSC. This is the largest study to date evaluating MDSC for the treatment of PVPS. This article is protected by copyright. All rights reserved.

Publisher URL: http://onlinelibrary.wiley.com/resolve/doi

DOI: 10.1111/bju.14125

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