Brian P. Jacob, David C. Chen, Bruce Ramshaw, Shirin Towfigh (eds.) - The SAGES Manual of Groin Pain-Springer International Publishing (2016)

26. Chronic Orchialgia: Workup and Management
349
Fig. 26.4. Nerve fiber with and without Wallerian degeneration on H&E staining
(From Brahmbhatt et al. [ 3 ], with kind permission Springer Science + Business
Media).
deferens after MDSC procedure, compared to sham (MDSC = 3.5
nerves, sham = 15.5 nerves, p = 0.003) [ 20 ]. In this procedure (described
in detail below), we target tissue in or around the spermatic cord that
carries high-density nerve fibers that contribute to chronic pain. Within
these nerve fiber s, there are significant anatomic and pathologic differences
(Wallerian degeneration) compared to controls (Fig. 26.4 ) [ 3 , 13 ].
Targeting these specific areas leads to the preservation of a significant
portion of the spermatic cord and potentially fewer complications.
We published our most updated results of the 546 robotic targeted
MDSC (RTMDSC) procedures for chronic groin pain [ 21 ]. On the last
review of our data our total has increased to over 620 patients. Mean
preoperative duration of orchialgia in our patients is 2.4 years.The
median robotic operative duration was 20 min (range, 10–150 min).
Using the externally validated pain assessment tool PIQ-6, we assessed
preoperative and postoperative pain. At 6 months there was a 71 % significant
reduction in pain and 72 % significant reduction at 1 year. Using
the visual analog pain scale, there was an 85 % significant reduction in
pain (63 % complete resolution and 22 % greater than 50 %).
Complications were limited to one testicular ischemia, two testicular
artery injuries (repaired intra-op with no long-term sequelae), one vasal