Chronic testicular pain is one of the most common complaints seen in the urologist’s office, and it continues to be a challenging entity to identify and treat. Conservative therapy is first-line treatment; however, when conservative treatment fails, surgical intervention may be indicated. Microsurgical spermatic cord denervation (MSCD), surgery on the microscopic nerves responsible for this type of pain, has become the treatment of choice for men in this situation. This operation has actually been performed since the 1970’s, but without a strong microanatomic understanding of which nerves are responsible for this kind of pain. This required a very thorough dissection throughout the entire spermatic cord which potentially put important structures at risk. Dr. Kavoussi traditionally performed MSCD denervation in this manner, until an elegant microanatomic study was performed in 2013 defining 3 specific nerve branches responsible for this type of testicular pain.
Following the data being published revealing the 3 specific nerve branches responsible for chronic testicular pain in the majority of men needing MSCD, Dr. Kavoussi changed his surgical technique to a targeted MSCD, focusing specifically on these 3 nerve branches. Dr. Kavoussi states, “This change in technique allows for much less dissection throughout the spermatic cord around important structures like arterial blood supplies to the testicles and lymphatic channels. Our study proves that we still achieve outstanding responses in pain improvement and resolution of pain with this technique compared to the older technique, with less risk to important structures, and much faster operative times, so we are not keeping patients under anesthesia for as long of periods”.
To read Dr. Kavoussi’s study on validation of targeted MSCD, click here…