Testicular pain following laparoscopic renal surgery

We have observed that a significant number of patients experience testicular pain following laparoscopic renal surgery. Since January 2006 all men scheduled for laparoscopic renal or adrenal surgery were followed prospectively to determine the incidence and characteristics of this pain.

All patients had a history and physical examination before surgery, during postoperative hospitalization and 4 weeks after surgery. Pain and tenderness were scored on a standard 10 point scale. Preoperative and postoperative data were collected prospectively.

A total of 64 male patients (68 sides) met the criteria for evaluation. Ipsilateral testicular pain developed in 14 patients (21%). All patients describing pain underwent donor or radical nephrectomy. Of the 20 patients who underwent donor nephrectomy 11 (55%) experienced pain and of the 15 treated with radical nephrectomy 3 (20%) experienced pain. The gonadal vein was preserved in 29 patients and of those patients 1 had testicular pain (3.4%). When the gonadal vein was ligated 13 of 39 patients (33%) experienced pain (OR 14, 95% CI 1.7-115, p = 0.003). Mean pain intensity was 4 (range 1 to 8) and improved in all patients. Pain ceased without any intervention at a median of 34 days after surgery (range 7 to 110). There were no differences in operative time or blood loss between patients with or without testicular pain.

Ipsilateral testicular pain can occur after laparoscopic renal surgery. The incidence is approximately 50% after donor nephrectomy but pain can also occur after radical nephrectomy. Preservation of the gonadal vein may be protective. We now warn all male patients scheduled for laparoscopic nephrectomy of the possibility of postoperative testicular pain.