Standard versus Targeted Microsurgical Denervation of Spermatic Cord for Chronic Orchialgia: A Prospective Comparative Study.

OBJECTIVES: To prospectively compare the safety and efficacy of standard versus targeted MDSC in patients with chronic orchialgia. METHODS: A prospective non-randomized comparative study including patients with unilateral idiopathic testicular pain persisting for more than three months and unresponsive to conservative treatment. Sixty patients were allocated into equal two groups; Group 1 (No= 30) underwent standard MDSC, and Group 2 (No= 30) underwent targeted MDSC. Pain was assessed using the visual analogue scale (VAS) preoperatively and at 1 week, 1 month, 6 months, and 12 months postoperatively. Primary outcomes included pain relief (complete, partial, or failure) and perioperative complications. RESULTS: Fifty patients completed the follow-up (27 in Group 1 and 23 in Group 2). Both groups showed significant improvement in VAS scores at all postoperative intervals compared to baseline (p < 0.001). Complete pain relief was achieved in 74.1% of patients in Group 1 and 60.9% in Group 2, while partial pain relief was reported in 18.5% and 26.1%, respectively. Minor postoperative complications occurred in four patients, without significant intergroup differences. CONCLUSIONS: Targeted MDSC offers similar efficacy for the management of patients with idiopathic chronic orchialgia with potentially reduced risk to spermatic cord microstructures.