Laparoscopic testicular denervation for chronic orchalgia

Jeffrey A Cadeddu, Jay T. Bishoff, David Y. Chan, Robert G. Moore, Louis R. Kavoussi, Thomas W. Jarrett

Research output: Contribution to journalArticle

41 Citations (Scopus)

Abstract

Purpose: No specific cause is identified in most cases of chronic orchialgia. Nonsurgical therapies, including management at a chronic pain clinic, are generally recommended. Only when multiple conservative measures fail are patients offered surgical intervention, such as orchiectomy. We evaluate laparoscopic testicular denervation as an organ preserving and minimally invasive surgical alternative. Materials and Methods: Since 1993, 9 patients with chronic orchialgia have undergone transperitoneal laparoscopic testicular denervation after nonsurgical modalities failed. Using 1, 10 mm. and 1 or 2, 5 mm. ports, the gonadal vessels were isolated circumferentially and divided cephalad to the vas deferens and its vasculature. Preoperative treatment modalities, morbidity and outcome were documented. A cord block provided temporary relief in all 9 patients. Analog scales were used to assess long-term pain relief (0 no pain to 100 worst pain) and activity levels (0 bedrest to 100 no restrictions). Results: Average symptom duration before laparoscopic testicular denervation was 4.1 years. Of 9 patients 8 had undergone prior scrotal surgery. Failed nonsurgical modalities included anti- inflammatory drugs in 7 patients, antibiotics in 6, pain clinic consultations in 4 and antidepressant medications in 2. Mean pain score decreased from 69.4 (range 35 to 90) preoperatively to 30.6 at a mean followup of 25.1 months. Excluding the 2 cases that had no pain relief (less than 10-point reduction), average pain score decreased from 69 to 19 postoperatively (mean reduction 71%). Activity levels improved in all cases. There were no significant complications, including testis atrophy. One patient who had no pain relief underwent subsequent hydrocelectomy for pain, which also failed. Conclusions: Laparoscopic testicular denervation can provide significant long-term pain relief and appears to be a reasonable alternative in select cases with chronic orchialgia refractory to medical therapy. Larger series and prospective evaluations are necessary.

Original languageEnglish (US)
Pages (from-to)733-736
Number of pages4
JournalJournal of Urology
Volume162
Issue number3 I
DOIs
StatePublished - Sep 1999

Fingerprint

Denervation
Pain
Pain Clinics
Bed Rest
Vas Deferens
Orchiectomy
Chronic Pain
Antidepressive Agents
Atrophy
Testis
Anti-Inflammatory Agents
Therapeutics
Referral and Consultation
Anti-Bacterial Agents
Morbidity

Keywords

  • Denervation
  • Laparoscopy
  • Pain
  • Testis

ASJC Scopus subject areas

  • Urology

Cite this

Cadeddu, J. A., Bishoff, J. T., Chan, D. Y., Moore, R. G., Kavoussi, L. R., & Jarrett, T. W. (1999). Laparoscopic testicular denervation for chronic orchalgia. Journal of Urology, 162(3 I), 733-736. https://doi.org/10.1097/00005392-199909010-00028

Laparoscopic testicular denervation for chronic orchalgia. / Cadeddu, Jeffrey A; Bishoff, Jay T.; Chan, David Y.; Moore, Robert G.; Kavoussi, Louis R.; Jarrett, Thomas W.

In: Journal of Urology, Vol. 162, No. 3 I, 09.1999, p. 733-736.

Research output: Contribution to journalArticle

Cadeddu, JA, Bishoff, JT, Chan, DY, Moore, RG, Kavoussi, LR & Jarrett, TW 1999, 'Laparoscopic testicular denervation for chronic orchalgia', Journal of Urology, vol. 162, no. 3 I, pp. 733-736. https://doi.org/10.1097/00005392-199909010-00028
Cadeddu JA, Bishoff JT, Chan DY, Moore RG, Kavoussi LR, Jarrett TW. Laparoscopic testicular denervation for chronic orchalgia. Journal of Urology. 1999 Sep;162(3 I):733-736. https://doi.org/10.1097/00005392-199909010-00028
Cadeddu, Jeffrey A ; Bishoff, Jay T. ; Chan, David Y. ; Moore, Robert G. ; Kavoussi, Louis R. ; Jarrett, Thomas W. / Laparoscopic testicular denervation for chronic orchalgia. In: Journal of Urology. 1999 ; Vol. 162, No. 3 I. pp. 733-736.
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