Spermatic cord denervation is a surgical procedure for chronic testicular pain, or orchialgia, considered after other treatments have failed. The operation involves selectively severing nerves within the spermatic cord that transmit pain signals from the testicle. This approach is intended to alleviate persistent pain while preserving the testicle’s primary functions.
Immediate Post-Surgical Effects
Following spermatic cord denervation, swelling and bruising in the scrotal area are common effects that subside within a couple of weeks. Pain at the incision site is a normal part of recovery and is managed with prescribed pain medication and rest. Applying ice packs to the scrotum for short intervals can help reduce swelling and discomfort during the initial 48 hours after surgery.
While some effects are normal, certain signs may indicate a complication requiring medical attention. The development of a fever, significant redness, heat, or pus draining from the incision can signal an infection. A substantial collection of blood under the skin, known as a hematoma, may also occur, though it is rare. Recovery involves restrictions on heavy lifting and sexual activity for a short period.
Long-Term Potential Complications
Months or years after surgery, a small number of patients may develop long-term complications. One such issue is a hydrocele, a collection of fluid in the sac surrounding the testicle. This can occur if lymphatic vessels responsible for draining fluid are damaged during the procedure. While microsurgical techniques lower this risk, a hydrocele may require a separate procedure to correct if it becomes large or uncomfortable.
Another infrequent complication is testicular atrophy, or the shrinkage of the testicle, resulting from an interruption of the testicular artery’s blood supply. Surgeons work to identify and preserve this artery using tools like micro-dopplers to ensure blood flow remains intact. Although microsurgery minimizes this risk, if atrophy occurs, it can affect the testicle’s size and structure. Patients might also experience a change or loss of sensation on the surface of the testicle.
Impact on Fertility and Sexual Function
A primary concern for many individuals is the procedure’s effect on fertility. The surgical technique is designed to target only the sensory nerves responsible for pain. Structures necessary for fertility, such as the vas deferens which transports sperm, are carefully preserved. The tube itself remains intact to maintain its function.
The procedure is not expected to interfere with sexual function. The nerves that control erections and ejaculation follow different pathways and are not located within the surgical field of spermatic cord denervation. Testosterone production is also preserved because the blood supply is maintained, so the ability to have an erection, ejaculate, and produce hormones is unaffected.
Risk of Continued or New Pain
Studies show the procedure is often effective, with 70-80% of selected patients experiencing significant or complete pain resolution. Success is more likely for patients who respond well to a pre-surgical spermatic cord block with a local anesthetic. However, the procedure is not always successful, and some individuals may find their pain is unchanged.
In some instances, patients may develop a new type of pain after the surgery. This can be caused by the formation of a neuroma, which is a disorganized growth of nerve tissue at the site where a nerve was cut. A neuroma can become a source of sharp, localized pain. The possibility of incomplete relief or the development of new nerve-related pain remains a consideration.