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

     

    Microsurgical spermatic cord deneveration, with and without sparing of the vas - Anand Shridharani, MD

     

     

     

     

     

    Dr. Craig: The surgeons demonstrate the importance of targeting and dividing structures of the spermatic cord, which contain a high volume of neural tissue. They demonstrate a more limited dissection and fewer number of transected structures compared to Dr. Williams’ technique, with a good response rate postoperatively. They also illustrate the ability to perform this type of procedure while preserving the vas deferens and therefore fertility.

    Dr. Hotaling: Dr. Shridharani elegantly demonstrates a nice use of vessel loops both to isolate the cremasteric fibers for ligation but also to provide exposure for dissection of delicate cord structures. In contrast to other videos, his team performs a less radical neurolysis but does demonstrate good outcomes. Their choice of removing 2 cm of the perivasal tissue is novel and could likely be easily incorporated into a vassal-sparing denervation. One advantage of their less extensive dissection is the lack of risk of a hydrocele due to the preservation of numerous lymphatic channels around the testicular artery. The use of Amniofix for improving postoperative pain relief is another novel technique that we. at the University of Utah Center for Men’s Health & Reconstructive Urology, have found to improve our success rates significantly.

    Anand Shridharani, MDAnand Shridharani, MD

    Dr. Shridharani is assistant professor of urology at University of Tennessee, Chattanooga College of Medicine, and staff urologist at Erlanger Hospital, Chattanooga, TN.

     

    Section Editor James M. Hotaling, MD, MSSection Editor James M. Hotaling, MD, MS

    Dr. Hotaling is assistant professor of surgery (urology) at the Center for Reconstructive Urology and Men's Health, University of Utah, Salt Lake City.

     


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