Department of Urology, Rush University Medical Center, Chicago, IL 60612, USA.
J Sex Med. 2013 Mar;10(3):876-82. doi: 10.1111/j.1743-6109.2012.02937.x. Epub 2012 Sep 27.
Microdenervation of the spermatic cord (MDSC) has been demonstrated to be an effective treatment for men with intractable scrotal content pain.
This study evaluates the correlation between a positive response to a spermatic cord block with local anesthetic and the subsequent surgical outcome following MDSC.
Pre- and post-cord block pain and pre- and post-MDSC pain.
A retrospective review of 74 patients (77 testicular units) who underwent MDSC from 2006 to 2010 was performed. Pre- and post-spermatic cord block pain scores based on a 0-10 visual analog scale (VAS) were compared with pre- and post-MDSC pain scores. A positive response to the block was defined as greater than or equal to 50% temporary reduction of pain based on VAS.
The average patient age was 42 years with a mean follow-up of 10 months. The mean duration of symptoms before surgery was 69 months. Mean pre-cord block pain score was 8 with an 89% average decrease in pain following the block. Mean post-MDSC pain score was 2 with an average decrease of 73%. The level of temporary improvement from the cord block appeared to be a useful predictor of sustained improvement with MDSC (P = 0.05). Positive response to spermatic cord block was an independent predictor of MDSC response (P = 0.03).
Men with chronic orchialgia who have a positive response to a spermatic cord block are likely to have durable and complete resolution of symptoms after undergoing MDSC. The amount of pain relief obtained after the cord block correlates with pain relief after undergoing a MDSC. Men with chronic orchialgia who desire surgical correction should undergo a preoperative spermatic cord block as part of their complete evaluation. The result of the cord block can help guide the practitioner and the patient toward definitive surgical management via MDSC.
已经证实精索微神经切断术（MDSC）可有效治疗顽固性阴囊内容物疼痛的男性患者。
本研究旨在评估精索阻滞麻醉阳性反应与随后 MDSC 手术结果之间的相关性。
精索阻滞麻醉前后的疼痛和 MDSC 前后的疼痛。
回顾性分析了 2006 年至 2010 年期间接受 MDSC 的 74 例（77 个睾丸单位）患者的资料。基于 0-10 视觉模拟评分（VAS）比较了精索阻滞麻醉前后的疼痛评分与 MDSC 前后的疼痛评分。根据 VAS，阻滞麻醉阳性反应定义为疼痛至少减少 50%。
患者平均年龄为 42 岁，平均随访时间为 10 个月。手术前症状平均持续时间为 69 个月。精索阻滞麻醉前疼痛平均评分为 8 分，阻滞麻醉后疼痛平均降低 89%。MDSC 后疼痛平均评分为 2 分，疼痛平均降低 73%。精索阻滞麻醉后的临时改善程度似乎是 MDSC 持续改善的有用预测指标（P = 0.05）。精索阻滞麻醉阳性反应是 MDSC 反应的独立预测因素（P = 0.03）。
慢性睾丸炎患者对精索阻滞麻醉有阳性反应，经 MDSC 治疗后，其症状可能会持久且完全缓解。精索阻滞麻醉后获得的疼痛缓解程度与 MDSC 后获得的疼痛缓解程度相关。希望接受手术矫正的慢性睾丸炎患者应在术前进行精索阻滞麻醉，作为其全面评估的一部分。精索阻滞麻醉的结果可以帮助指导医生和患者通过 MDSC 进行确定性手术治疗。
