Abstract: PD69-09
Sources of Funding: None

Introduction

Chronic scrotal content pain is a difficult condition to treat. Microsurgical denervation of the spermatic cord (MDSC) is one surgical treatment option with success rates published in the 60-85% range. However, patients who fail MDSC have limited options. Botulinum-A toxin (Botox) has been shown to modulate the release of neuropeptides leading to inhibition of neurogenic inflammation and chronic pain. This provides an antinociceptive effect. Our goal was to assess the use of peri-spermatic cord Botox injections (Scrotox) to provide prolonged pain relief in men with refractory chronic scrotal content pain after MDSC.

Methods

Retrospective review of 44 patients who underwent Scrotox (60 procedures: 30 bilateral, 15 right side, 15 left side) from July 2013 to July 2016. All patients had failed prior MDSC. 100 units of Botox diluted in 10cc of saline was injected medial and lateral to the spermatic cord at the level of the external inguinal ring to ablate branches of the genitofemoral, ilioinguinal and inferior hypogastric nerves. The primary outcome measure was the level of pain. Pain was assessed preoperatively and postoperatively using two assessment tools: a) the subjective visual analog scale (VAS) and b) an objective standardized externally validated pain assessment tool (PIQ-6, QualityMetric Inc., Lincoln, RI).

Results

Median age was 45 years. Median duration of pain prior to the procedure was 9 years. Median follow up post procedure was 7 months. Subjective VAS patient pain outcomes: 62.5% significant reduction in pain (7.5% complete resolution, 55% reported a greater than 50% reduction in pain) by 3 months post-op. Objective PIQ-6 outcomes: significant reduction in pain in 27% of patients at 6 months and 40% at 1 year post-op. There were no complications in our cohort.

Conclusions

Scrotox is a potentially safe and viable treatment option for the salvage management of persistent chronic scrotal content pain in patients who have failed MDSC. Further studies are warranted to better understand the long-term durability of this treatment modality.

Funding

None