Vasectomy is a safe and effective method of contraception used by 42-60 million men worldwide. Approximately 3%-6% of men opt for a vasectomy reversal due to the death of a child or divorce and remarriage, change in f...Vasectomy is a safe and effective method of contraception used by 42-60 million men worldwide. Approximately 3%-6% of men opt for a vasectomy reversal due to the death of a child or divorce and remarriage, change in financial situation, desire for more children within the same marriage, or to alleviate the dreaded postvasectomy pain syndrome. Unlike vasectomy, vasectomy reversal is a much more technically challenging procedure that is performed only by a minority of urologists and places a larger financial strain on the patient since it is usually not covered by insurance. Interest in this procedure has increased since the operating microscope became available in the 1970s, which consequently led to improved patency and pregnancy rates following the procedure. In this clinical update, we discuss patient evaluation, variables that may influence reversal success rates, factors to consider in choosing to perform vasovasostomy versus vasoepididymostomy, and the usefulness of vasectomy reversal to alleviate postvasectomy pain syndrome. We also review the use of robotics for vasectomy reversal and other novel techniques and instrumentation that have emerged in recent years to aid in the success of this surgery.展开更多
The objective was to assess whether men suffering from testicular retraction secondary to hyperactive cremaster muscle reflex havean anatomic difference in the thickness of the cremaster muscle in comparison to men wh...The objective was to assess whether men suffering from testicular retraction secondary to hyperactive cremaster muscle reflex havean anatomic difference in the thickness of the cremaster muscle in comparison to men who do not have retraction. From March2021 to December 2021, 21 men underwent microsurgical subinguinal cremaster muscle release (MSCMR) on 33 spermatic cordunits, as 12 of them had bilateral surgery, at Surgicare of South Austin Ambulatory Surgery Center in Austin, TX, USA. Duringthat same time frame, 36 men underwent subinguinal microsurgical varicocele repair on 41 spermatic cord units, as 5 werebilateral for infertility. The thickness of cremaster muscles was measured by the operating surgeon in men undergoing MSCMRand varicocele repair. Comparison was made between the cremaster muscle thickness in men with testicular retraction due toa hyperactive cremaster muscle reflex undergoing MSCMR and the cremaster muscle thickness in men undergoing varicocelerepair for infertility with no history of testicular retraction, which served as an anatomic control. The mean cremaster musclethickness in men who underwent MSCMR was significantly greater than those undergoing varicocele repair for infertility, witha mean cremaster muscle thickness of 3.9 (standard deviation [s.d.]: 1.2) mm vs 1.0 (s.d.: 0.4) mm, respectively. Men withtesticular retraction secondary to a hyperactive cremaster muscle reflex demonstrate thicker cremaster muscles than controls,those undergoing varicocele repair. An anatomic difference may be a beginning to understanding the pathology in men whostruggle with testicular retraction.展开更多
Background Chronic scrotal content pain(CSCP)is a devastating condition characterized by localized scrotal pain that persists for≥3 months and interferes with daily activities.Approximately 2.5%of all urology outpati...Background Chronic scrotal content pain(CSCP)is a devastating condition characterized by localized scrotal pain that persists for≥3 months and interferes with daily activities.Approximately 2.5%of all urology outpatient visits are associated with CSCP.General urologists may have difficulty treating these patients because of uncertainties regarding the etiology and pathophysiology of CSCP.Therefore,we aimed to provide a simplified diagnostic and treatment approach for CSCP by subdividing it into distinct categories.Materials and methods We systematically reviewed the published literature in the PubMed,MEDLINE,and Cochrane databases for all reports on CSCP diagnosis and treatment using the keywords“chronic scrotal content pain,”“testicular pain,”“orchialgia,”“testicular pain syndrome,”“microdenervation of the spermatic cord,”“post-vasectomy pain syndrome,”“post-inguinal hernia repair pain,”“testialgia,”and“pudendal neuralgia.”This review included only CSCP-related articles published in English language.Results We subdivided CSCP syndrome into 5 clinical presentation types,including hyperactive cremasteric reflex,pain localized in the testicles,pain in the testis,spermatic cord,and groin,pain localized in the testicles,spermatic cord,groin,and pubis,and pain in the testicles,spermatic cord/groin,and penis/pelvis.Treatments were adjusted stepwise for each type and section.We included more information regarding the role of pudendal neuroglia in CSCP syndrome and discussed more options for nerve blocks for CSCP.For microsurgical spermatic cord denervation failure,we included treatment options for salvage ultrasound-guided targeted cryoablation,Botox injections,and posterior-inferior scrotal denervation.Conclusions Different CSCP subtypes could help general urologists assess the appropriate diagnostic and treatment approaches for scrotal pain management in daily practice.展开更多
文摘Vasectomy is a safe and effective method of contraception used by 42-60 million men worldwide. Approximately 3%-6% of men opt for a vasectomy reversal due to the death of a child or divorce and remarriage, change in financial situation, desire for more children within the same marriage, or to alleviate the dreaded postvasectomy pain syndrome. Unlike vasectomy, vasectomy reversal is a much more technically challenging procedure that is performed only by a minority of urologists and places a larger financial strain on the patient since it is usually not covered by insurance. Interest in this procedure has increased since the operating microscope became available in the 1970s, which consequently led to improved patency and pregnancy rates following the procedure. In this clinical update, we discuss patient evaluation, variables that may influence reversal success rates, factors to consider in choosing to perform vasovasostomy versus vasoepididymostomy, and the usefulness of vasectomy reversal to alleviate postvasectomy pain syndrome. We also review the use of robotics for vasectomy reversal and other novel techniques and instrumentation that have emerged in recent years to aid in the success of this surgery.
文摘The objective was to assess whether men suffering from testicular retraction secondary to hyperactive cremaster muscle reflex havean anatomic difference in the thickness of the cremaster muscle in comparison to men who do not have retraction. From March2021 to December 2021, 21 men underwent microsurgical subinguinal cremaster muscle release (MSCMR) on 33 spermatic cordunits, as 12 of them had bilateral surgery, at Surgicare of South Austin Ambulatory Surgery Center in Austin, TX, USA. Duringthat same time frame, 36 men underwent subinguinal microsurgical varicocele repair on 41 spermatic cord units, as 5 werebilateral for infertility. The thickness of cremaster muscles was measured by the operating surgeon in men undergoing MSCMRand varicocele repair. Comparison was made between the cremaster muscle thickness in men with testicular retraction due toa hyperactive cremaster muscle reflex undergoing MSCMR and the cremaster muscle thickness in men undergoing varicocelerepair for infertility with no history of testicular retraction, which served as an anatomic control. The mean cremaster musclethickness in men who underwent MSCMR was significantly greater than those undergoing varicocele repair for infertility, witha mean cremaster muscle thickness of 3.9 (standard deviation [s.d.]: 1.2) mm vs 1.0 (s.d.: 0.4) mm, respectively. Men withtesticular retraction secondary to a hyperactive cremaster muscle reflex demonstrate thicker cremaster muscles than controls,those undergoing varicocele repair. An anatomic difference may be a beginning to understanding the pathology in men whostruggle with testicular retraction.
文摘Background Chronic scrotal content pain(CSCP)is a devastating condition characterized by localized scrotal pain that persists for≥3 months and interferes with daily activities.Approximately 2.5%of all urology outpatient visits are associated with CSCP.General urologists may have difficulty treating these patients because of uncertainties regarding the etiology and pathophysiology of CSCP.Therefore,we aimed to provide a simplified diagnostic and treatment approach for CSCP by subdividing it into distinct categories.Materials and methods We systematically reviewed the published literature in the PubMed,MEDLINE,and Cochrane databases for all reports on CSCP diagnosis and treatment using the keywords“chronic scrotal content pain,”“testicular pain,”“orchialgia,”“testicular pain syndrome,”“microdenervation of the spermatic cord,”“post-vasectomy pain syndrome,”“post-inguinal hernia repair pain,”“testialgia,”and“pudendal neuralgia.”This review included only CSCP-related articles published in English language.Results We subdivided CSCP syndrome into 5 clinical presentation types,including hyperactive cremasteric reflex,pain localized in the testicles,pain in the testis,spermatic cord,and groin,pain localized in the testicles,spermatic cord,groin,and pubis,and pain in the testicles,spermatic cord/groin,and penis/pelvis.Treatments were adjusted stepwise for each type and section.We included more information regarding the role of pudendal neuroglia in CSCP syndrome and discussed more options for nerve blocks for CSCP.For microsurgical spermatic cord denervation failure,we included treatment options for salvage ultrasound-guided targeted cryoablation,Botox injections,and posterior-inferior scrotal denervation.Conclusions Different CSCP subtypes could help general urologists assess the appropriate diagnostic and treatment approaches for scrotal pain management in daily practice.
