Stripping versus ligation of vas deferens in microscopic denervation of spermatic cord in men with chronic orchialgia: A multicenter study

Adnan El-Achkar; Muhammed Hammad; David Barham; Chad A Service; Darshan Patel; Tung Chin Hsieh; Jesse Mills; Reza Kianian; Sriram Eleswarapu; Matthew Ziegelmann; Ryan Smith; Darren Bryk; Helen L Bernie; Melissa Egert; Omer Raheem; Kiarad Fendereski; Kelli Gross; Alex Pastuszak; James Hotaling; Faysal Yafi

doi:10.1111/andr.13650

Stripping versus ligation of vas deferens in microscopic denervation of spermatic cord in men with chronic orchialgia: A multicenter study

Andrology. 2024 Apr 19. doi: 10.1111/andr.13650. Online ahead of print.

Authors

Adnan El-Achkar¹, Muhammed Hammad², David Barham², Chad A Service³, Darshan Patel³, Tung Chin Hsieh³, Jesse Mills⁴, Reza Kianian⁴, Sriram Eleswarapu⁴, Matthew Ziegelmann⁵, Ryan Smith⁶, Darren Bryk⁶, Helen L Bernie⁷, Melissa Egert⁷, Omer Raheem⁸, Kiarad Fendereski⁹, Kelli Gross⁹, Alex Pastuszak⁹, James Hotaling⁹, Faysal Yafi²

Affiliations

¹ Department of Urology, American University of Beirut, Beirut, Lebanon.
² Department of Urology, University of California Irvine, Orange, California, USA.
³ Department of Urology, University of California San Diego, San Diego, California, USA.
⁴ David Geffen School of Medicine, UCLA, Los Angeles, California, USA.
⁵ Department of Urology, Mayo Clinic, Rochester, Minnesota, USA.
⁶ Department of Urology, University of Virginia, Charlottesville, Virginia, USA.
⁷ Department of Urology, Indiana University, Indianapolis, Indiana, USA.
⁸ Department of Urology, University of Chicago, Chicago, Illinois, USA.
⁹ Department of Urology, University of Utah, Salt Lake City, Utah, USA.

PMID: 38639020
DOI: 10.1111/andr.13650

Abstract

Background: Microdenervation of the spermatic cord (MSCD) is an effective treatment modality for men with intractable scrotal content pain. For patients not interested in preserving fertility, some centers advocate ligation of the vas during denervation, while others prefer stripping of the vas deferens to preserve the vasal artery, hence preserving vasculature to the testis and possibly decreasing post-operative congestion pain.

Objective: To compare outcomes of patients with chronic orchialgia, who underwent MSCD by either stripping or ligating the vas deferens.

Materials and methods: A retrospective chart review of 85 patients who underwent MSCD from 2017-2023 was performed. Patients' demographics including history of prior surgical procedures were recorded. Response to surgery was evaluated as either complete resolution of pain, partial resolution of pain, or no improvement in pain.

Results: Eighty-five patients underwent MSCD with a median (interquartile range, IQR) age of 36 (25.5-46.5) years and median duration of pain of 16 (6-31) months. Thirty-seven patients underwent stripping of vas, while 48 underwent ligation of vas during MSCD. Median follow up was 12 months. Twenty-one (43.5%) patients had prior inguinal scrotal surgery in the ligation group compared to 5 (13.5%) in the stripping group, p = 0.003. The etiology of pain was similar between the groups. The response to MSCD between the two groups was similar, 67.6% of patients who underwent stripping had complete resolution of pain versus 66.7% of those who had ligation (p = 0.968), with similar rates of post-operative complications (p-value = 0.132).

Conclusions: In men with intractable chronic scrotal content pain with no interest in preserving fertility, ligation, or stripping of the vas deferens yields similar outcomes with regard to pain resolution. Both techniques are safe with no reports of any testicular atrophy.

Keywords: chronic scrotal pain; ligation of vas; microscopic denervation of spermatic cord; surgical technique; treatment outcomes.