LAUSR

OBJECTIVE To improve the technique and results of microsurgical denervation of the spermatic cord (MDSC) for men with chronic scrotal content pain (CSCP), we describe a novel approach at the level of the internal inguinal ring for the complete transection of the nerves running both inside and outside the spermatic cord for adults and children. METHODS A retrospective review of 52 patients (64 testicular units) who underwent high inguinal MDSC was performed. Visual analogue scale (VAS, 1-10) scores were compared with before and every three months after the surgery. Depressive symptoms were assessed by the Beck Depression Inventory. Hormonal evaluations were performed before and six months after the surgery. RESULTS The average patient age was 52.4 years (12 to 78); including six pediatric cases. The mean operative time was 67 minutes per testicular unit, and there were no major complications. The mean pre- and post-MDSC VAS scores were 8.3 and 2.5, respectively (p<0.0001). Forty-six (88%) cases showed positive responses after MDSC, and multivariate analysis showed that pain outside the scrotum and depressive symptoms were predictors of MDSC failure (p<0.05, odds ratio: 15.27 and 12.56, respectively). CONCLUSIONS For both adult and pediatric patients, high inguinal MDSC is an effective and safe management option, including testicular function, for the CSCP that is refractory to medical management. We find that the high inguinal approach is easier in our experience than the subinguinal approach because of fewer divisions of veins, a larger diameter of the spermatic artery.