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    Cord denervation: Surgeons describe microsurgical techniques in men with scrotal pain


    Microsurgical denervation of the spermatic cord for testicular pain - Daniel H. Williams, IV, MD






    Dr. Williams performs a microsurgical denervation of the spermatic cord in a patient with severe testicular pain that was refractory to medical therapy. This is an outpatient, same-day procedure. A small subinguinal incision is made. Using the operating microscope and a micro-doppler ultrasound, critical structures including testicular arteries and lymphatics are preserved. Venous drainage occurs via the gubernacular veins. All other structures are ligated to provide anesthesia and durable pain relief to the affected testicle.

    Dr. Craig: The surgeon demonstrates his method of spermatic cord denervation. Highlights of his video include performing this through a subinguinal location with a small and concealable incision, identification and preservation of the testicular artery with the assistance of a micro-doppler, preservation of lymphatic channels, and transection of the vas deferens as well as the vasal packet—a prime location for a large volume of neural tissue.

    Dr. Hotaling: Dr. Williams performs a radical neurolysis here, preserving only the testicular artery and a few lymphatic channels. We have found that preservation of a few of these channels is critical to prevent hydrocele formation. This dissection leaves only the critical structures behind and, in expert hands, offers outstanding success rates of 75% to 90%.

    Daniel H. Williams, IV, MDDaniel H. Williams, IV, MD

    Dr. Williams is associate professor of urology, obstetrics and gynecology, residency program director, and director of male reproductive medicine and microsurgery at the University of Wisconsin School of Medicine and Public Health, Madison.



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