Stripping versus ligation of vas deferens in microscopic denervation of spermatic cord in men with chronic orchialgia: A multicenter study

• DOI: 10.1111/andr.13650
• Publication Date: 2024-04-19T07:34:27Z
• Authors: Adnan El‐Achkar; Muhammed Hammad; David Barham; Chad A Service; Darshan Patel; Tung Chin Hsieh; Jesse Mills; Reza Kianian; Sriram Eleswarapu; Matthew Ziegelmann; Ryan Smith; Darren Bryk; Helen L Bernie; Melissa Egert; Omer Raheem; Kiarad Fendereski; Kelli Gross; Alex Pastuszak; James Hotaling; Faysal Yafi
• Keywords: Male; Spermatic Cord; Adult; Microsurgery; microscopic denervation of spermatic cord; ligation of vas; 610; treatment outcomes; Middle Aged; surgical technique; Denervation; Testicular Diseases; Vas Deferens; Treatment Outcome; 0302 clinical medicine; 617; chronic scrotal pain; Humans; Original Article; Chronic Pain; Ligation; Retrospective Studies

AbstractBackgroundMicrodenervation of the spermatic cord (MSCD) is an effective treatment modality for men with intractable scrotal content pain. For patients not interested in preserving fertility, some centers advocate ligation of the vas during denervation, while others prefer stripping of the vas deferens to preserve the vasal artery, hence preserving vasculature to the testis and possibly decreasing post‐operative congestion pain.ObjectiveTo compare outcomes of patients with chronic orchialgia, who underwent MSCD by either stripping or ligating the vas deferens.Materials and methodsA retrospective chart review of 85 patients who underwent MSCD from 2017–2023 was performed. Patients’ demographics including history of prior surgical procedures were recorded. Response to surgery was evaluated as either complete resolution of pain, partial resolution of pain, or no improvement in pain.ResultsEighty‐five patients underwent MSCD with a median (interquartile range, IQR) age of 36 (25.5–46.5) years and median duration of pain of 16 (6–31) months. Thirty‐seven patients underwent stripping of vas, while 48 underwent ligation of vas during MSCD. Median follow up was 12 months. Twenty‐one (43.5%) patients had prior inguinal scrotal surgery in the ligation group compared to 5 (13.5%) in the stripping group, p = 0.003. The etiology of pain was similar between the groups. The response to MSCD between the two groups was similar, 67.6% of patients who underwent stripping had complete resolution of pain versus 66.7% of those who had ligation (p = 0.968), with similar rates of post‐operative complications (p‐value = 0.132).ConclusionsIn men with intractable chronic scrotal content pain with no interest in preserving fertility, ligation, or stripping of the vas deferens yields similar outcomes with regard to pain resolution. Both techniques are safe with no reports of any testicular atrophy.