精索显微去神经术：历史回顾与最新进展

Microsurgical Denervation of the Spermatic Cord: A Historical Perspective and Recent Developments.

作者信息

Sun Helen H, Tay Kimberly S, Jesse Erin, Muncey Wade, Loeb Aram, Thirumavalavan Nannan

机构信息

Urology Institute, University Hospitals/Case Western Reserve University School of Medicine, Cleveland, OH, USA.

出版信息

Sex Med Rev. 2022 Oct;10(4):791-799. doi: 10.1016/j.sxmr.2021.11.005. Epub 2022 Jan 5.

DOI:10.1016/j.sxmr.2021.11.005

PMID:34996747

Abstract

INTRODUCTION

The management of chronic scrotal pain is long and varied, with historical treatment algorithms typically ending with orchiectomy. Microsurgical denervation of the spermatic cord (MDSC) is a testicle-sparing option for patients who have failed conservative treatment options and over its forty-year history has seen many technical refinements.

OBJECTIVES

To review the history and development of MDSC and discuss the outcomes of different surgical techniques.

METHODS

A literature review using PubMed and Google Scholar was conducted to identify studies pertaining to surgical treatment of CSP, MDSC, and outcomes. Search terms included "chronic," "scrotal pain," "orchialgia," "spermatic cord," "denervation," and "microsurgery."

RESULTS

We included 21 case reports and series since the first seminal paper describing MDSC technique in 1978. Additional studies that challenged existing conventions or described novel techniques are also discussed. The current standard procedure utilizes a subinguinal incision and a surgical microscope. Open, robotic, and laparoscopic approaches to MDSC have been described, but access to minimally invasive instruments may be limited outside of developed nations. Pain reduction following preoperative spermatic cord predicts success of MDSC. Methods for identifying and preserving the testicular and deferential arteries vary depending on surgeon preference but appear to have comparable outcomes. Future developments in MDSC involve targeted denervation, minimizing collateral thermal injury, and alternative techniques to visualize arterial supply.

CONCLUSION

For patients suffering from CSP, MDSC is a well-studied technique that may offer appropriately selected patients' relief. Future investigation comparing targeted vs full MDSC as well as in vivo study of new techniques are needed to continue to improve outcomes. Sun HH, Tay KS, Jesse E, et al. Microsurgical Denervation of the Spermatic Cord: A Historical Perspective and Recent Developments. Sex Med Rev 2022;10:791-799.

摘要

引言

慢性阴囊疼痛的治疗过程漫长且多样，传统的治疗方案通常以睾丸切除术告终。精索显微去神经术（MDSC）是一种为保守治疗失败的患者保留睾丸的选择，在其40年的历史中经历了许多技术改进。

目的

回顾MDSC的历史与发展，并讨论不同手术技术的效果。

方法

通过PubMed和谷歌学术进行文献综述，以确定与慢性阴囊疼痛（CSP）的手术治疗、MDSC及效果相关的研究。检索词包括“慢性”“阴囊疼痛”“睾丸痛”“精索”“去神经术”和“显微外科手术”。

结果

自1978年第一篇描述MDSC技术的开创性论文发表以来，我们纳入了21篇病例报告和系列研究。还讨论了其他挑战现有传统或描述新技术的研究。目前的标准手术采用腹股沟下切口和手术显微镜。已描述了MDSC的开放、机器人和腹腔镜手术方法，但在发达国家以外，获得微创器械的途径可能有限。术前精索疼痛减轻预示着MDSC手术成功。识别和保留睾丸动脉与输精管动脉的方法因外科医生的偏好而异，但效果似乎相当。MDSC未来发展包括靶向去神经术、将侧支热损伤降至最低以及可视化动脉供应的替代技术。