Microscopic Cord Denervation for Scrotal Pain

Scrotal pain is often related to issues with one or both testicles or a collection of nerves, vessels, and ducts that are connected to the testes, known as the spermatic cord. Neurologic diseases, trauma, and infection are among the common sources of discomfort in the scrotum that may require surgical intervention if pain remains consistent and disruptive.

A less-invasive option a urologist may recommend to relieve scrotal pain is a microscopic cord denervation.

Prior to suggesting surgery, a urologist performs tests that might include scrotal ultrasound to rule out other possible problems and pinpoint the specific issues with the spermatic cord. A urologist surgeon may also administer a local anesthetic cord block to temporarily block nerve signals coming from the cord. If the patient notices a reduction in pain, it can be assumed that the spermatic cord is likely the main source of the discomfort felt in the scrotum. If there is little or no difference in pain, there is likely another source of the patient’s symptoms.

During the operation, a small groin incision is made in a way that’s similar to how hernia surgery is done. If a patient had a previous hernia operation, the incision is usually made through the existing scar. With the guidance of a surgical microscope, the various components of the cord are slowly dissected to preserve the testicular artery and as many lymphatic vessels as possible. This is usually done with a special microsurgical probe. If a man wishes to preserve fertility, the vas deferens can also remain in place. Otherwise, it will be divided and the cord will be “stripped” down to its essential components. The surgical wound is then closed with sutures that will be absorbed over time, which eliminates the need for stitch removal.

It usually takes 1-2 hours to complete the procedure. Care will need to be taken when bathing or showering to avoid irritating the surgical site until it has healed. Since nerves are cut, the affected testicle usually remains numb. If the ilioinguinal nerve is divided, there may be reduced sensation on part of the scrotum and along the inner thigh. More than 90 percent of patients who’ve had a microscopic cord denervation report successful elimination or reduction of pain.

As with other types of urological problems, microscopic cord denervation is rarely the first attempt at treating scrotal pain. It’s usually when symptoms continue after trying medication and other conservative treatments for testicular or scrotal pain aren’t successful that surgery is considered. Underlying health issues and the patient’s overall health are also typically taken into account when determining if microscopic cord denervation is the best option when surgery is needed.

While it’s possible to develop scrotal pain that’s serious enough to require microscopic cord denervation or a similar procedure from a sudden injury, men are more likely to experience testicular/scrotal pain if they’ve had previous surgery in the same area. Additional risk factors include having had a vasectomy and having a history of epididymitis or orchitis. A urologist may also suggest testing for testicular cancer and other conditions that can cause scrotal pain if surgery doesn’t fully resolve symptoms or discomfort.