Steps We Follow to Treat Testicular Pain

  1. Spermatic Cord block

A precise minimally invasive delivery of local anesthetics at predefined locations along the spermatic cord to assess if specific nerve fiber de-activation provides pain relief for the patient. If this resolves the pain, then the pain is likely to be of neurologic origin due to hypersensitive pain nerve fibers.

The cord block usually only provides temporary relief (hours, days or weeks, depending on the individual patient and their baseline pain characteristics). A patient who responds to the cord block (even transiently) is likely to be a good candidate for denervation of the spermatic cord, which will usually provide permanent relief. The nerve distribution is quite complex in the cord, and we believe that because we may miss some of the critical nerves with a cord block, we may be able to do a more precise and more targeted lysis or ligation with microscope. This may explain why many patients who do not respond to the block may respond to targeted denervation or neurolysis.

If patients do not want to jump into denervation or neurolysis, we may try targeted peri-spermatic cord and/or ilioinguinal nerve Botox ablation. Botox ablation has been used for chronic pain nerve syndromes, and we are now utilizing this technique in patients with complex pain that does not seem to respond to the above mentioned techniques.

We perform this only if the patient has had a response to a previous targeted block. If the block seemed to give them some temporary relief in pain, then they may be a candidate for Botox ablation. We are currently getting good success rate in significantly reducing pain in patients who undergo this procedure, but are still not sure of the long-term durability of this technique. It is likely that patients may require one or two more of these blocks after a few months.

  1. Microsurgical denervation of the spermatic cord

We perform a highly specialized, targeted, microsurgical dissection of the nerve fiber complex in the spermatic cord that we think is responsible for the pain, and ligate them to hopefully achieve permanent pain relief. This technique involves a small 1-2 cm skin incision in the groin and then dissection through the spermatic cord in a minimally invasive manner.

This procedure is performed with real-time intra-operative Doppler identification and protection of the testicular arteries to prevent any potential testicular atrophy or injury.

We focus greatly on the targeted denervation technique to ensure that patients have minimal side effects and should not have any decreased sensation in the testicle, and no effect on their erections and sexual function. The goal is simply to relieve the patient from the chronic testicular and/or groin pain while minimizing any loss of other functionality.

  1. Microsurgical vasectomy reversal

In a small percentage of men who have previously undergone a vasectomy, there may be chronic groin or testicular pain. This pain can range from mild irritation to debilitating pain that requires chronic pain medication use. In some of these men with specific findings of episodic pain, especially after ejaculation, or episodic pressure sensation, microscopic vasectomy reversal may be a treatment option.

This modality is utilized if the patient does not respond to a cord block. Successful relief of pain may be achieved in up to 75% of patients undergoing microsurgical vasectomy reversal. Currently, we achieve a 75-80% success rate in significantly reducing post-vasectomy congestive type pain after this type of reversal.