Efficacy of Targeted vs Standard Spermatic Cord Denervation in the Management of Chronic Orchialgia: A Comparative Study

Background: Chronic orchialgia, defined as testicular or scrotal pain persisting for more than three months, remains a challenging condition to treat, often leading to significant impairment in quality of life. While conservative management including pharmacotherapy and nerve blocks offers initial relief, many patients experience persistent symptoms requiring surgical intervention. Microsurgical spermatic cord denervation (MSCD) has emerged as an effective technique; however, the comparative efficacy of targeted versus complete MSCD remains inadequately explored. Objective: To evaluate and compare the clinical outcomes of targeted versus complete spermatic cord denervation in patients with chronic orchialgia unresponsive to conservative treatment. Methods: This comparative study was conducted over two years at a tertiary care hospital and included 50 male patients aged 18–55 years with chronic orchialgia lasting more than three months. After diagnosis confirmation via clinical evaluation and spermatic cord block using 5 mL of 1% lidocaine with 40 mg triamcinolone, patients were randomly allocated into two equal groups. Group A (n=25) underwent complete MSCD involving skeletonization of the spermatic cord, while Group B (n=25) underwent targeted MSCD focusing on the cremasteric muscle, peri-vasal sheath, and posterior lipomatous tissues. Pain outcomes were assessed using the Visual Analog Scale (VAS) at baseline and 6-month follow-up. Results: In the complete denervation group, 19 patients (76%) experienced complete pain resolution, 2 (8%) had partial relief, and 4 (16%) showed no improvement. In the targeted group, 18 patients (72%) achieved complete resolution, 1 (4%) had partial relief, and 6 (24%) reported no improvement. Statistical analysis revealed no significant difference between groups (p > 0.05). Conclusion: Both targeted and complete MSCD are effective for treating chronic orchialgia. Given its less invasive nature, targeted denervation may be a suitable alternative in appropriately selected patients.