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

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J.V. Brahmbhatt et al.
Salvage Interventions Post Targeted Denervation
Microcryoablation
Approximately, 12–15 % of patients will have persistent pain after
denervation [ 21 , 24 ]. Orchiectomy and epididymectomy could be considered;
however, these procedures seem to be controversial due to their
low success rates [ 25 – 27 ]. Mirmovich et al. introduced intralesional
cryosurgery for the treatment of the pain due to hypertrophic scars and
keloids [ 28 ]. We adapted their technique and perform microcryoablation
of ilioinguinal and genitofemoral nerve fibers for patients with persistent
or recurrent CGSCP [ 29 ]. A small diameter EndoCare CryoProbe
(Healthtronics, Austin, TX) is used to perform cryoablation of the
medial and lateral edges of the cord under ultrasound guidance
(Fig. 26.13 ). As of September 2014, we have performed 69 targeted
microcryoablations in 60 patients (9 b/l, 22 left, 29 right). At median
follow-up of 11 months using the visual analog pain scale, there is a
74 % significant reduction in pain (9 % complete resolution and 65 %
greater than 50 % reduction in pain). Using the PIQ6 score, there is
59 % reduction in pain at 6 months. Complications were rare and
included one wound infection and one case of increased penile pain.
Fig. 26.13. Ultrasound guidance during microcryoablation.