Ipsilateral orchialgia after laparoscopic donor nephrectomy

Complications related to laparoscopic donor nephrectomy (LDN) have been similar to those associated with open renal donor nephrectomy (ODN). However, during clinical follow-up, we noted a group of male patients who developed acute ipsilateral orchialgia after LDN. In an effort to assess the incidence of this problem, determine the etiology, and adapt preventive measures, we reviewed our experience.

A retrospective chart review was performed on 381 consecutive LDNs performed between February 1995 and November 2001 to assess for postoperative orchialgia. There were 157 male patients (41.2%) in our series. Our technique involves ligation of the gonadal vessels, periureteral tissue, and ureter over the iliac artery using either surgical clips or a linear laparoscopic GIA stapler.

Left-sided nephrectomy was performed in 145 (92.3%) male patients, of whom 14 (9.6%) complained of ipsilateral orchialgia. Statistical analysis (t-test) of the orchialgia and non-orchialgia groups with respect to operative time, estimated blood loss, warm ischemia time, and ureteral length revealed no statistical differences (P>0.1). Onset of testicular pain occurred on average at postoperative day 5 (range days 1-14). The mean follow-up was 24.4 +/- 14.8 months (range 6-52 months). Ten patients were evaluated with transcrotal duplex ultrasonography. One patient with decreased flow and was managed conservatively, while one patient without detectable testicular flow underwent surgical exploration. One patient underwent spermatocelectomy and had improvement but not resolution of pain. The remaining patients were treated conservatively with nonsteroidal anti-inflammatory medication and empiric antibiotics. Seven patients (50%) had complete spontaneous resolution of orchialgia on average 6.3+/-7.2 months after LDN.

Laparoscopic donor nephrectomy has proven to be an effective and safe surgical procedure. However, further evaluation has demonstrated a complication not previously reported, namely ipsilateral orchialgia. The etiology remains unclear but may be injury to the sensory nerves of the testicle during dissection of the periureteral tissue or transection of the spermatic cord. Further anatomic and physiological studies are needed to elucidate the pathophysiology of this problem.