Tuan Le Anh, Dung Mai Ba Tien, Hieu Le Dinh, Chuyen Vu Le, Mai Viet Nhat Tan, El-Achkar Adnan, Hammad Muhammed A Moukhtar, Nguyen Tuan Thanh
Department of General Surgery, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam.
Department of Andrology, Binh Dan Hospital, Ho Chi Minh City, Vietnam.
Transl Androl Urol. 2025 Apr 30;14(4):1015-1024. doi: 10.21037/tau-2024-719. Epub 2025 Apr 21.
Chronic scrotal pain (CSP) frequently persists following varicocelectomy, significantly impacting patients' quality of life and posing considerable therapeutic challenges. Recently, microsurgical denervation of the spermatic cord (MDSC) has emerged as a promising surgical alternative for managing CSP refractory to conventional varicocelectomy. This study evaluates the efficacy of MDSC as a treatment for CSP in patients who did not achieve symptomatic relief after varicocelectomy.
From March 2021 to March 2023, we conducted a retrospective cohort study of 45 male patients aged ≥18 years with persistent CSP following varicocelectomy. Inclusion criteria included patients unresponsive for more than three months post-varicocelectomy to medical treatments, including nonsteroidal anti-inflammatory drugs (NSAIDs), antidepressants, and anticonvulsants, and who demonstrated significant pain reduction following a spermatic cord block (SCB). Pain was assessed using the Numeric Rating Scale (NRS), a self-reported tool ranging from 0 to 10. All patients underwent MDSC based on their positive response to SCB.
The average follow-up period was 14.0 months. Participants experienced significant pain reduction, with mean NRS pain scores decreasing from 7.5 pre-treatment to 1.7 following the SCB, and slightly rising to 1.8 post-operation. Significant pain relief, defined as a reduction of more than 50% in NRS score, was observed in 84.4% of cases. Minimal complications were reported, including one instance of surgical site infection, one case of postoperative bleeding, and two occurrences of numbness and burning sensations.
MDSC is a safe and effective option for the management of CSP in patients unresponsive to varicocelectomy, providing substantial pain relief with minimal complications.
精索静脉曲张切除术后慢性阴囊疼痛（CSP）常常持续存在，严重影响患者的生活质量，并带来巨大的治疗挑战。最近，精索神经显微去神经术（MDSC）已成为一种有前景的手术替代方案，用于治疗对传统精索静脉曲张切除术无效的CSP。本研究评估MDSC作为精索静脉曲张切除术后未获得症状缓解的患者CSP治疗方法的疗效。
2021年3月至2023年3月，我们对45例年龄≥18岁、精索静脉曲张切除术后患有持续性CSP的男性患者进行了一项回顾性队列研究。纳入标准包括精索静脉曲张切除术后对包括非甾体抗炎药（NSAIDs）、抗抑郁药和抗惊厥药在内的药物治疗无反应超过三个月，且在精索内神经阻滞（SCB）后疼痛明显减轻的患者。使用数字评分量表（NRS）评估疼痛，这是一种自我报告工具，范围为0至10。所有患者基于对SCB的阳性反应接受MDSC。
平均随访期为14.0个月。参与者的疼痛显著减轻，NRS疼痛评分均值从治疗前的7.5降至SCB后的1.7，并在术后略有上升至1.8。84.4%的病例观察到显著的疼痛缓解，定义为NRS评分降低超过50%。报告的并发症极少，包括1例手术部位感染、1例术后出血以及2例麻木和烧灼感。
对于对精索静脉曲张切除术无反应的患者，MDSC是一种安全有效的CSP治疗选择，可提供显著的疼痛缓解且并发症极少。
