Microdenervation of the spermatic cord has been demonstrated to be an effective method for managing chronic orchialgia, a persistent pain condition that can profoundly affect patients' quality of life. In this video, we present our standardized protocol for the treatment of chronic orchialgia, with a particular focus on the procedural details of microdenervation.

A 25-year-old man presented with refractory chronic scrotal pain that had persisted for five years, significantly impacting his daily activities. He had previously undergone bilateral laparoscopic varicocelectomy to alleviate scrotal pain, but this intervention was unsuccessful. Subsequently, a bilateral epididymectomy was performed at another hospital; however, the pain persisted despite these and other conservative treatments. Seeking further management, the patient visited our outpatient department. Physical examination and Duplex scrotal ultrasound ruled out structural abnormalities, including torsion, hydrocele, and spermatocele. A spermatic cord block was then administered in the high scrotal region using 10 mL of 2% lidocaine. Given his positive response, demonstrated by temporary pain reduction following the cord block, the patient was considered a suitable candidate for microdenervation of the spermatic cord. Microdenervation of the spermatic cord was performed by subinguinal approach following the 'Trifecta Nerve Complex' template, targeting key denervation sites as follows: the Intra-Cremasteric Complex, the Peri-Vasal Complex, and the Posterior Peri-Arterial/Lipomatous Complex.

Bilateral microdenervation of the spermatic cord was successfully completed. Postoperatively, the patient reported a numerical rating scale (NRS) pain score of 0, indicating complete resolution of scrotal pain.

Microdenervation of the spermatic cord (MDSC) offers a reliable and effective method for managing chronic orchialgia, particularly in cases where pain affects multiple scrotal structures, such as the testis, epididymis and spermatic cord. MDSC should be regarded as the primary surgical option for alleviating pain while preserving the testicle.