Microsurgical denervation of the rat spermatic cord and its connection to the diagnosis and treatment of chronic orchialgia: a bench to bedside experience

Chronic orchialgia is a common urologic problem, however, determination of the etiology is often difficult and the pathophysiology is poorly understood. As a result, there is no clear algorithm for surgical treatment for men who have failed conservative medical treatment. This review aims to describe microsurgical denervation of the rat spermatic cord and summarize several surgical techniques that have been described in the literature ranging from orchiectomy to epididymectomy to vasectomy reversal for post-vasectomy orchialgia. More recent studies advocate for microsurgical denervation of the spermatic cord, which can be performed with a standard operating microscope or laparoscopic/robotic techniques providing optical magnification. Data regarding efficacy and complications for all surgical treatments is outlined. Experimental modalities, such as the use of multiphoton microscopy (MPM) to identify and ablate nerves surrounding the vas deferens are also described. Finally, given the fact that chronic orchialgia often affects young men, we summarize safety data generated from an animal model regarding the effect of microsurgical denervation on the structure and function of the testis and vas deferens.