精索微神经切断术治疗输精管结扎术后疼痛综合征。

Microdenervation of the spermatic cord for post-vasectomy pain syndrome.

机构信息

Division of Urology, Rush University Medical Center, Chicago, IL, USA.

出版信息

BJU Int. 2018 Apr;121(4):667-673. doi: 10.1111/bju.14125. Epub 2018 Feb 9.

DOI:10.1111/bju.14125

PMID:29352521

Abstract

OBJECTIVE

To evaluate the outcomes of patients who underwent microdenervation of the spermatic cord (MDSC) for post-vasectomy pain syndrome (PVPS) at our institution.

METHODS

A retrospective study of all patients who underwent MDSC for PVPS by a single surgeon between March 2002 and 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 score ≤1 for >4 h. All patients had failed medical therapy prior to MDSC. All previous procedures for PVPS had been performed elsewhere. Surgical success was defined as a postoperative NRS score of ≤1.

RESULTS

A total of 27 patients with 28 scrotal units underwent MDSC for PVPS. The median (1st quartile; 3rd quartile) follow-up was 10 (2; 16.5) months. The median (range) duration of pain prior to surgery was 57 (8-468) months. Pain was bilateral in 14 (52%), left-sided in eight (30%) and right-sided in five patients (19%). Data on SCB were available for 23 patients, with a success rate of 96%. The median (range) preoperative pain NRS score was 7 (2-10). The median (range) pain score after SCB on the NRS scale was 0 (0-5). The median (range) postoperative pain score on the NRS was 0 (0-9). Overall success was achieved in 20 of 28 testicular units (71%). Patients with involvement of multiple structures in the scrotum (i.e. testis, epididymis, spermatic cord) had a success rate of 81% and were more likely to have a successful surgery (P < 0.001). Five patients had failed a prior epididymectomy and three had failed a vaso-vasostomy for PVPS; this had no correlation with the success of MDSC (P = 0.89).

CONCLUSION

The MDSC procedure is a reasonably successful, durable and valuable approach for PVPS, especially when pain involves multiple structures in the scrotum (testis, epididymis, spermatic cord). MDSC was equally efficacious in patients who had previously failed a procedure for PVPS. No patient had a worsening NRS score after MDSC. This is the largest study to date evaluating MDSC for the treatment of PVPS.

摘要

目的

评估本机构行精索微神经切断术（MDSC）治疗精索结扎术后疼痛综合征（PVPS）患者的结局。

方法

对 2002 年 3 月至 2016 年 10 月间由同一位外科医生行 MDSC 治疗 PVPS 的所有患者进行回顾性研究。采用数字评分量表（NRS）对疼痛进行记录。所有患者均行精索阻滞（SCB），成功定义为 NRS 评分≤1 且持续＞4 h。所有患者均在接受 MDSC 治疗前已接受过药物治疗。所有之前的 PVPS 治疗均在其他地方进行。术后成功定义为 NRS 评分≤1。

结果

27 例 28 个阴囊单位行 MDSC 治疗 PVPS。中位（1 四分位距；3 四分位距）随访时间为 10（2；16.5）个月。术前疼痛持续时间的中位数（范围）为 57（8-468）个月。14 例（52%）为双侧疼痛，8 例（30%）为左侧疼痛，5 例（19%）为右侧疼痛。23 例患者的 SCB 数据可用，成功率为 96%。术前 NRS 疼痛评分中位数（范围）为 7（2-10）。SCB 后 NRS 评分中位数（范围）为 0（0-5）。NRS 术后疼痛评分中位数（范围）为 0（0-9）。28 个睾丸单位中 20 个（71%）获得总体成功。阴囊内多个结构受累（即睾丸、附睾、精索）的患者成功率为 81%，更有可能获得手术成功（P＜0.001）。5 例患者曾因 PVPS 行附睾切除术失败，3 例患者行输精管吻合术失败，与 MDSC 成功率无相关性（P=0.89）。