Microsurgical denervation of the spermatic cord as primary surgical treatment of chronic orchialgia.

PURPOSE: We evaluate the effectiveness of microsurgical denervation of the spermatic cord for treatment of chronic orchialgia. MATERIALS AND METHODS: Patients referred to our clinic diagnosed with chronic orchialgia are evaluated with a thorough medical and psychiatric history, physical examination and scrotal ultrasound when indicated. A total of 27 patients with chronic orchialgia refractory to nonsurgical management who had temporary pain relief after undergoing outpatient cord block were candidates for denervation. There were 6 patients who had bilateral pain, therefore, 33 testicular units were denervated. Followup ranged from 1 to 74 months (mean 20). RESULTS: Complete pain relief was noted in 25 (76%) testicular units, partial relief in 3 (9.1%) and no relief in the remaining 5 (15%), with a mean followup of 19, 24 and 10 months, respectively. There was no significant difference in outcome when evaluated by the etiology of orchialgia. CONCLUSIONS: When conservative treatment fails, microsurgical denervation of the spermatic cord should be considered first rate surgical therapy for patients with chronic orchialgia.

Preoperative semen analysis as a predictor of seminal improvement following varicocelectomy.

OBJECTIVE: To determine the predictive role of preoperative semen analysis on both seminal improvement and pregnancy rates following varicocelectomy. DESIGN: Retrospective data analysis. SETTING: Two academic medical center infertility clinics. PATIENT(S): One hundred ten consecutive patients who underwent varicocelectomies. Seminal improvement data were available for 84 patients, and pregnancy data were available for 58 patients. INTERVENTION(S): Stratification of patients based on preoperative total motile sperm count (TM). Varicocelectomy was performed on all patients. MAIN OUTCOME MEASURE(S): TMs, pregnancy rates, and conception techniques following varicocelectomy of each preoperative group. RESULT(S): Men with mild to moderate oligoasthenospermia (TM >5 million) had significantly better seminal improvement following varicocelectomy. While preoperative stratification showed no difference in pregnancy rates (when assisted reproductive techniques were included), men who achieved a postoperative TM >20 million were more likely to achieve conception by less invasive techniques (natural and intrauterine insemination vs. in vitro fertilization [IVF]). CONCLUSION(S): Varicocelectomy may be the most cost-effective initial intervention in males with TM >5 million. Patients with TM <5 million and concomitant female factor infertility may be better initial candidates for IVF.

Renal medullary carcinoma in patients with sickle cell trait.

Renal medullary carcinoma has recently been described as an aggressive neoplasm affecting young African Americans with sickle cell disease or sickle cell trait. We report the presentation, treatment, and outcome in 3 patients with renal medullary carcinoma along with a description of the unsuccessful treatment attempts. A brief discussion and review of the literature is included.

Microsurgical denervation of the spermatic cord: a surgical alternative in the treatment of chronic orchialgia.

PURPOSE: We demonstrated effective treatment of chronic orchialgia by microsurgical denervation of the spermatic cord. MATERIALS AND METHODS: Seven men with a history of chronic orchialgia (mean duration 16.6 months) underwent this surgical procedure after conservative treatment failed. A bupivacaine spermatic cord block resulted in temporary pain relief. RESULTS: There was an excellent correlation between the response to preoperative temporary cord nerve block and the surgical result. Six men had complete and permanent pain relief after surgery. One patient with bilateral orchialgia had complete unilateral relief and partial relief on the contralateral side. There was no complaint of postoperative regional hypoesthesia. CONCLUSIONS: Microsurgical denervation of the spermatic cord is an effective testicular sparing surgical alternative for the treatment of chronic orchialgia.