What is Microsurgical Denervation of the Spermatic Cord (MDSC)?

MDSC is a microscopic, very accurate surgical technique. It is intended to sever the tiny nerves inside the spermatic cord that are thought to be carrying chronic pain impulses from the testicle or epididymis (the tube at the rear of the testicle that holds and transports sperm). The goal of precisely locating and severing these pain-conducting nerves is to prevent the pain while leaving other vital structures intact such as blood vessels and the vas deferens (the sperm-carrying tube).

What type of symptoms would make one opt for MDSC?

MDSC is usually reserved for chronic (persistent) testicular pain or chronic scrotal pain. Such pain is typically:

Persistent: For at least three months.
Provocative: Bad enough to interfere with daily life, work, or activity.
Unresponsive to other treatments: The individual has typically attempted medications, injections, or other less severe therapies without relief.
Often localised: The pain is typically experienced in the testicle, epididymis, or even radiating into the groin or lower abdomen.
Can vary: It may be a dull ache, a stabbing pain, or a burning quality. It may be constant or intermittent.

What are the underlying causes of chronic testicular pain that MDSC may treat?

Chronic pain in the testicles can have numerous origins, and MDSC is contemplated when the pain is believed to be "neuropathic," i.e., from irritated or harmed nerves. The following are some common causes that may lead to the consideration of MDSC:

Post-vasectomy pain syndrome: Pain that occurs after a vasectomy.
Post-herniorrhaphy pain: Pain after hernia repair surgery.
Epididymitis/Orchitis (following resolution of infection): Pain that persists even after treatment of an infection or inflammation of the epididymis or testicle.
Testicular trauma: Pain after a testicular injury.
Varicocele: Although varicoceles are usually painful, when surgery to correct them is not successful in eliminating pain, nerve-related pain may be the cause.
Idiopathic pain: In some cases, no obvious cause of pain is identified, but it's thought to be nerve-related.

Are there any risk factors for MDSC in treating chronic testicular pain?

Although not direct risk factors for MDSC, some circumstances raise the risk for developing chronic testicular pain that may later result in a consideration of MDSC:

Prior surgery in the scrotum or groin: Like vasectomy, herniorrhaphy, or hydrocele (fluid surrounding the testicle).
Prior history of epididymitis or orchitis: Nerve pain may persist even after treatment.
Testicular trauma or injury.
Specific medical conditions include diabetes or shingles, which can affect nerves.
Unknowable causes: In most instances, the specific risk factor is unknown.

What are the possible complications of MDSC?

As with any surgery, MDSC does have some risks, but they are usually minimal due to the microsurgical technique:

Relief of pain: The primary concern is that the pain may not be fully eliminated or may recur.
Numbness: You may feel numbness around the scrotum or thigh region.
Bruising or swelling: Usual after surgery.
Infection: At the wound site.
Hematoma: A blood accumulation under the skin.
Damage to blood vessels or vas deferens: Although uncommon with microsurgery, this could impact testicular blood supply or fertility.
Development of hydrocele: A fluid buildup about the testicle may need additional treatment.
Worsening of chronic pain (rare): Although relief is the aim, pain can worsen or continue in rare situations.

How is chronic testicular pain diagnosed before considering MDSC?

To rule out alternative reasons and assess if MDSC is appropriate, diagnosing chronic testicular pain requires a comprehensive process:

Detailed Medical History: Your doctor will ask about your pain, its onset, duration, severity, and what makes it better or worse.
Physical Examination: To check for abnormalities, tenderness, or masses.
Urine Tests: To rule out urinary tract infections or STIs.
Blood Tests: To look for signs of inflammation or infection.
Scrotal Ultrasound: This scan enables visualisation of the testicles, epididymis, and nearby structures to exclude diseases such as tumors, cysts, or fluid accumulation.
MRI (Magnetic Resonance Imaging) is rare but can be employed in certain situations for detailed imaging of soft tissues.
Spermatic Cord Block: This is an important diagnostic procedure. A local anesthetic is injected into the spermatic cord. If your pain improves dramatically after injection, it means that the pain is actually originating from the nerves in the spermatic cord and MDSC is a more probable successful treatment.

What does the treatment (MDSC) involve?

Here is a general description of the MDSC procedure:

Anesthesia: Most commonly it's done under general anesthesia, so you'll be asleep during the procedure.
Incision: An incision is made in the relatively small groin area.
Isolation of Spermatic Cord: The surgeon then identifies and carefully considers the spermatic cord.
Microsurgical Dissection: The surgeon employs a high-powered operating microscope to carefully dissect the different parts of the spermatic cord. They only cut the small nerves that are thought to carry pain signals, leaving intact the vas deferens (sperm tube), testicular artery (testicular blood supply), and lymphatic vessels.
Closure: The incision is closed with sutures.
Recovery: It's generally an outpatient procedure, so you can head home the same day. You will have some soreness and swelling at the incision area, which can be controlled with pain medication. Most individuals can return to light activities in a few days to a week. Heavy activities and lifting are usually limited for a few weeks.

Can chronic testicular pain be prevented? Are there methods to prevent needing MDSC?

Chronic testicular pain cannot be easily prevented due to the many causes, some of which are unknown. Still, some general tips can be helpful:

Early treatment of infections: If you develop epididymitis or orchitis, treat it early to minimise the risk of persistent pain.
Proper post-surgical care: If you are getting a vasectomy or hernia repair, talk to your surgeon about managing pain.
Protective gear: Use proper protective equipment when playing sports or engaging in activities that put the testicles at risk of injury.
Prompt treatment for pain: If you experience pain in the testicles, don't do anything about it. Consult a doctor to get the condition diagnosed and treated early as it may not become chronic.
Conservative treatments first: Prior to seeking MDSC, your physician may suggest a series of conservative treatments such as pain medications, anti-inflammatory medication, heat/cold packs, support briefs, and occasionally nerve-specific medications.

When should one get medical care for pain in the testicles?

Always get medical care for pain in the testicles, particularly if it is:

Sudden and severe: This might be a medical emergency such as testicular torsion (twisted testicle), which needs to be addressed urgently.
With fever, cold, or nausea.
With swelling, redness, or tenderness of the scrotum.
It will last for more than a few days.
Caused by trauma.
Affecting your quality of life.

Why choose Tender Palm Super Speciality Hospital for Microsurgical denervation of the spermatic cord (MDSC) Surgery in Lucknow, India?

Tender Palm Super-Speciality Hospital is one of the best hospitals for Microsurgical denervation of the spermatic cord (MDSC) Surgery in Lucknow, India. Our experienced Urologists uses advanced technology, and provides patient-focused care, the hospital ensures safer procedures, quicker recovery, and improved long-term outcomes.