Related Experiment Video
Updated: Aug 18, 2026
Clinical Application of 24 G Cannula Needle and 3-0 Polypropylene Suture in Vas Deferens Exploration
Published on: February 10, 2023
Microscopic Spermatic Cord Denervation for Chronic Scrotal Content Pain Following Inguinal Hernia Repair: Outcomes
Makenna E Romanelli1, Bryan D Naelitz2, Raevti Bole2
1Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH; Case Western Reserve University School of Medicine, Cleveland, OH.
Objective:
To characterize the effect of microscopic spermatic cord denervation (mSCD) on chronic scrotal content pain (CSCP) after inguinal hernia repair (IHR) and identify factors associated with pain resolution.
Methods:
We conducted a retrospective chart review of patients who underwent mSCD for CSCP following IHR from January 2018 to June 2024 at a single academic medical center. Patient demographics, medical history, IHR surgical parameters, and postoperative self-reported pain assessments were collected. Patients were categorized as having complete, partial, or no resolution of pain. Univariate regression analysis was performed to identify predictors of pain resolution.
Results:
Forty-two patients with CSCP following IHR who underwent mSCD were included. Five patients underwent bilateral mSCD, resulting in 47 cases for analysis. Pain resolved completely in 43% (n = 20/47) and improved in 87% (n = 41/47) of cases as assessed at a median follow-up time of 7 weeks (IQR: 6-14 weeks). No patient factors or IHR operative parameters were associated with complete pain resolution on univariate analysis. Patients who reported no improvement in pain (14%, n = 6/42) were younger (33 vs 58 years, P = .03) and more likely to have a history of levator tenderness/spasm (50 vs 7%, P = .02).
Conclusion:
mSCD results in palliation of CSCP in most patients with prior IHR. mSCD may be less likely to benefit younger patients and those with a history of levator tenderness/spasm. General surgeons should consider urologic referral for mSCD in this patient population.
Insights
Microscopic spermatic cord denervation (mSCD) effectively treats chronic scrotal pain after inguinal hernia repair (IHR). Younger patients and those with levator tenderness may see less benefit from this procedure.
Area of Science:
- Urology
- General Surgery
- Pain Management
Background:
- Chronic scrotal content pain (CSCP) can significantly impact quality of life after inguinal hernia repair (IHR).
- Microscopic spermatic cord denervation (mSCD) is a potential treatment option for refractory CSCP.
- Identifying factors influencing treatment outcomes is crucial for patient selection and management.
Purpose of the Study:
- To evaluate the effectiveness of mSCD in alleviating CSCP post-IHR.
- To identify patient-specific or surgical factors associated with successful pain resolution following mSCD.
Main Methods:
- Retrospective chart review of patients undergoing mSCD for CSCP after IHR.
- Data collection included demographics, medical history, surgical details, and pain assessments.
- Univariate regression analysis was used to determine predictors of pain resolution.
Main Results:
- mSCD led to complete pain resolution in 43% and improvement in 87% of 47 cases.
- Median follow-up was 7 weeks.
- Younger patients (33 vs. 58 years) and those with levator tenderness/spasm (50% vs. 7%) were less likely to achieve pain improvement.
Conclusions:
- mSCD offers significant palliation for CSCP following IHR in the majority of patients.
- Younger age and a history of levator tenderness/spasm may predict poorer outcomes.
- Referral to urology for consideration of mSCD is recommended for general surgeons managing these complex pain cases.
