(116) OUTPATIENT SURGICAL MANAGEMENT FOR CHRONIC SCROTAL PAIN
Bibliographic record
Abstract
Abstract Introduction Chronic scrotal pain is a prevalent and difficult condition to manage. It presents a diagnostic and therapeutic challenge due to its diverse etiology and variable clinical manifestations. While some cases can be attributed to identifiable causes such as infection, trauma, or surgical interventions, a considerable portion remains idiopathic. Many patients continue to experience persistent pain despite conservative treatment. Surgical interventions like epididymectomy, vasovasostomy, and microdenervation of the spermatic cord (MDSC) have been documented in the literature as potential options for chronic scrotal pain. Objective In our study, we aimed to evaluate the safety and effectiveness of outpatient surgical interventions for patients dealing with chronic scrotal pain. Methods We conducted a review of our prospective patient database of consecutive patients who underwent epididymectomy, vasovasostomy, or microdenervation of the spermatic cord (MDSC) for chronic scrotal pain at our outpatient surgical center. All patients followed a standardized patient flow. Patients were initially seen by a family physician at our center and trailed on conservative management. Patients who failed conservative management were then assessed by a urologist and offered surgical management depending on the location and character of the pain. Patients exhibiting localized epididymal pain, bilateral post-vasectomy discomfort, or generalized scrotal pain with a positive response to cord block were offered epididymectomy, vasovasostomy, or MDSC respectively. Safety and efficacy evaluations were performed through postoperative follow-up appointments at 1-2 months and 6-12 months. Results From August 2022 to May 2024, 94 patients underwent surgery for chronic scrotal pain. Demographics, perioperative, and follow-up data can be seen in Table 1. Among epididymectomy patients (n = 52), 42 patients had complete resolution of pain and 6 patients reported >50% improvement in pain. Of 3 men with recurrent pain, 2 were pain free after orchiectomy and MDSC respectively. 2 patients had small non-operative hematomas. Among vasovasostomy patients (n = 10), 6 patients had completely resolution of pain and 3 patients reported >50% improvement in pain. 1 patient had acute scrotal pain immediately post-op that was self-limited. Among MDSC patients (n = 32), 21 patients had complete resolution of pain and 7 patients reported >50% improvement in pain. Greater than 80% of patients were satisfied with the outcome of their procedure and expressed they would undergo the same procedure again. Conclusions Effective management of chronic scrotal pain remains a multifaceted problem involving conservative and surgical options. Consistent with the literature, our study found that outpatient epididymectomy, vasovasostomy, and MDSC are safe and effective surgical options for patients with chronic scrotal pain in carefully selected patients. Our study highlights the importance of standardized patient flow in selecting the appropriate patient for each surgical option. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.014 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".