Preoperative Predictors of Failure of Microsurgical Spermatic Cord Denervation for Men With Chronic Orchialgia

Objective To evaluate predictors of failure of microsurgical spermatic cord denervation (MSCD) for men with chronic orchialgia. Methods Retrospective chart review of men who underwent MSCD. Outcomes were recorded with potential preoperative predictors of failure. Results One hundred and five men underwent MSCD, and of those, 38 were bilateral for a total of 143 testicular units. Overall, 97 of 143 (67.8%) had complete resolution of pain, 27 of 143 (18.9%) had improvement of pain, and 19 of 143 (13.3%) were considered failures with either no improvement or less than 50% improvement in pain after MSCD with a 1-year follow-up period. Overall, 59 of 143 (41%) presented with intermittent orchialgia while 84 of 143 (59%) presented with constant pain. The mean preoperative visual analog scale was 6.8 ± 2 and the mean duration of pain prior to MSCD was 62.5 ± 100 months. Potential etiologies of pain per testicular unit included previous scrotal/inguinal surgery 17 of 143 (11.9%), postvasectomy pain syndrome (PVPS) 30 of 143 (21%), infectious epididymitis 9 of 143 (6.3%), trauma 15/143 (10.5%), and idiopathic 72/143 (50.3%). The only pre-operative predictor having an association with predicting failure was the etiology of orchialgia. Relative to men who had idiopathic orchialgia or prior scrotal/inguinal surgery inciting orchialgia, men with PVPS had increased odds of failure with MSCD. Conclusion PVPS is an etiology associated with a higher risk of failure to respond to MSCD than idiopathic chronic orchialgia or chronic orchialgia subsequent to scrotal/inguinal surgery.