(116) OUTPATIENT SURGICAL MANAGEMENT FOR CHRONIC SCROTAL PAIN
Authors: Lu S , Dhillon H , Nayak J , Patel P 
Published: December 2024

Abstract

Introduction
Chronic scrotal pain is a prevalent and difficult condition to manage. It presents a diagnostic and therapeutic challenge due to its diverse etiology and variable clinical manifestations. While some cases can be attributed to identifiable causes such as infection, trauma, or surgical interventions, a considerable portion remains idiopathic. Many patients continue to experience persistent pain despite conservative treatment. Surgical interventions like epididymectomy, vasovasostomy, and microdenervation of the spermatic cord (MDSC) have been documented in the literature as potential options for chronic scrotal pain.

Objective
In our study, we aimed to evaluate the safety and effectiveness of outpatient surgical interventions for patients dealing with chronic scrotal pain.

Methods
We conducted a review of our prospective patient database of consecutive patients who underwent epididymectomy, vasovasostomy, or microdenervation of the spermatic cord (MDSC) for chronic scrotal pain at our outpatient surgical center. All patients followed a standardized patient flow. Patients were initially seen by a family physician at our center and trailed on conservative management. Patients who failed conservative management were then assessed by a urologist and offered surgical management depending on the location and character of the pain. Patients exhibiting localized epididymal pain, bilateral post-vasectomy discomfort, or generalized scrotal pain with a positive response to cord block were offered epididymectomy, vasovasostomy, or MDSC respectively. Safety and efficacy evaluations were performed through postoperative follow-up appointments at 1-2 months and 6-12 months.

Results
From August 2022 to May 2024, 94 patients underwent surgery for chronic scrotal pain. Demographics, perioperative, and follow-up data can be seen in Table 1. Among epididymectomy patients (n = 52), 42 patients had complete resolution of pain and 6 patients reported &gt;50% improvement in pain. Of 3 men with recurrent pain, 2 were pain free after orchiectomy and MDSC respectively. 2 patients had small non-operative hematomas. Among vasovasostomy patients (n = 10), 6 patients had completely resolution of pain and 3 patients reported &gt;50% improvement in pain. 1 patient had acute scrotal pain immediately post-op that was self-limited. Among MDSC patients (n = 32), 21 patients had complete resolution of pain and 7 patients reported &gt;50% improvement in pain. Greater than 80% of patients were satisfied with the outcome of their procedure and expressed they would undergo the same procedure again.

Conclusions
Effective management of chronic scrotal pain remains a multifaceted problem involving conservative and surgical options. Consistent with the literature, our study found that outpatient epididymectomy, vasovasostomy, and MDSC are safe and effective surgical options for patients with chronic scrotal pain in carefully selected patients. Our study highlights the importance of standardized patient flow in selecting the appropriate patient for each surgical option.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific.