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ABSTRACT: PURPOSE: To identify structural abnormalities in the spermatic cord nerves that may explain how microsurgical denervation of the spermatic cord (MDSC) provides pain relief in patients with chronic orchialgia. MATERIALS AND METHODS: Retrospective review of a prospective database: comparing spermatic cord biopsy specimens of men undergoing MDSC (57 cases) for chronic orchialgia versus a control group of men without pain undergoing cord surgery (4 varicocelectomies and 6 radical orchiectomies). Tissue biopsies were obtained from mapped regions of the spermatic cord in all cases. Biopsies then examined (H&E staining) by an independent pathologist. Three human cadaver spermatic cord dissections were performed to confirm localization of the nerve distribution identified on pathology mapping. RESULTS: Median of 25 small diameter (<1 mm) nerve fibers identified within the spermatic cord. 84% (48/57) of the orchialgia patients had Wallerian degeneration in at least one or more of these nerves. Only 20% (2/10) patients had Wallerian degeneration in the control group (p=0.0008). There were 3 primary locations (the trifecta nerve complex) for these changes, listed in decreasing order of nerve density: cremasteric muscle fibers (19 nerves/patient), peri-vasal tissues and vasal sheath (9 nerves/patient), and posterior cord lipomatous/peri-vessel tissues (3 nerves/patient). The cord nerve distribution mapped by the biopsies was confirmed in the cadaver dissections. CONCLUSIONS: In men with chronic orchialgia, there appears to be Wallerian degeneration in reproducible patterns in the spermatic cord nerve fibers. Transection of these nerves may explain the effect of the denervation procedure.
The Journal of urology 01/2013; · 4.02 Impact Factor
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ABSTRACT: The introduction of the operative microscope for andrological surgery in the 1970s provided enhanced magnification and accuracy, unparalleled to any previous visual loop or magnification techniques. This technology revolutionized techniques for microsurgery in andrology. Today, we may be on the verge of a second such revolution by the incorporation of robotic assisted platforms for microsurgery in andrology. Robotic assisted microsurgery is being utilized to a greater degree in andrology and a number of other microsurgical fields, such as ophthalmology, hand surgery, plastics and reconstructive surgery. The potential advantages of robotic assisted platforms include elimination of tremor, improved stability, surgeon ergonomics, scalability of motion, multi-input visual interphases with up to three simultaneous visual views, enhanced magnification, and the ability to manipulate three surgical instruments and cameras simultaneously. This review paper begins with the historical development of robotic microsurgery. It then provides an in-depth presentation of the technique and outcomes of common robotic microsurgical andrological procedures, such as vasectomy reversal, subinguinal varicocelectomy, targeted spermatic cord denervation (for chronic orchialgia) and robotic assisted microsurgical testicular sperm extraction (microTESE).Asian Journal of Andrology advance online publication, 17 December 2012; doi:10.1038/aja.2012.131.
Asian Journal of Andrology 12/2012; · 1.52 Impact Factor
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ABSTRACT: Microsurgical vasectomy reversal is a technically demanding procedure. Previous studies have shown the possible benefit of robotic assistance during such procedures. Our goal was to compare robotic assisted vasovasostomy and vasoepididymostomy to standard microsurgical vasovasostomy (MVV) and vasoepididymostomy (MVE). The use of robotic assistance for vasectomy reversal may provide the microsurgeon with improved visualization, elimination of tremor, and decreased fatigue and obviate the need for a skilled microsurgical assistant. This study provides the first clinical prospective control trial of robotic assisted versus pure microsurgical vasectomy reversal. The use of robotic assistance in microsurgical vasovasostomy and vasoepididymostomy may have benefit over MVV and MVE with regards to decreasing operative duration and improving the rate of recovery of postoperative total motile sperm counts based on our study.
Journal of Reconstructive Microsurgery 06/2012; 28(7):435-44. · 1.43 Impact Factor
