Introduction: Microsurgical denervation of the spermatic cord (MDSC) has been shown to be a treatment option for men with intractable orchialgia/scrotal content pain. The standard of care is to perform a spermatic cord block to assess if there is any temporary relief in the pain prior to performing MDSC. This study assesses the predictive value of a spermatic cord block (SCB) with local anesthetic in determining post-MDSC outcomes.
Methods: A retrospective review of 1261 MDSC cases (1112 patients, 149 bilateral cases) from October 2008 to July 2019 was performed. An analysis of how the patients who had temporary relief in their pain (greater than 50% reduction) after a spermatic cord block correlated to their final outcome after MDSC was performed. The outcome after MDSC was graded as complete relief (CR) in pain, greater than 50% reduction in pain (PR) or no response (NR), defined as <50% reduction in pain. This outcome was based on preop and post-op measurements of pain using a validated quality of life metric (PIQ-6) and the visual analogue pain score (VAS).
Results: The positive predictive value (PPV) of a patient having a response to SCB and then achieving CR or PR was 78%, and achieving CR alone was 41%. The negative predictive value (NPV) of a patient who did not have any relief with SCB, and then achieving NR after MDSC was 57%.
Conclusions: This study illustrates that if a patient has no response to SCB, MDSC is less likely to help reduce pain in these patients. However, a positive response to SCB confers a high likelihood of significant reduction in pain after MDSC. Source of