Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Hydrodissection for improved microsurgical denervation of the spermatic cord: prospective blinded randomized control trial in a rat model

International Journal of Impotence Research volume 33, pages 118–121 (2021)Cite this article

Subjects

Abstract

Microsurgical denervation of the spermatic cord (MDSC) can provide up to an 86% improvement in pain in patients with chronic orchialgia (CO) who have failed conservative management. Failures in MDSC could be due to small diameter nerves (≤1 mm) left behind on the spermatic cord. The objective of this study was to assess if hydrodissection (HD) of the spermatic cord after MDSC could decrease the number of residual nerve fibers without compromising blood flow. Prospective blinded randomized control trial: bilateral MDSC was performed on 22 adult rats (44 cords). HD of the spermatic cord was performed on one side of each rat (side randomized) using the ERBEJET2. The contralateral cord (no HD) was the control for each animal. Blood flow through the vessels was monitored using a micro-Doppler probe. After completion a cross-section of the residual cord was sent to pathology (blinded to technique) to assess for small diameter nerves and signs of damage in vascular integrity. Blood flow had been maintained in the vessels when the ERBEJET2 was set to 6 bar (87 psi). The cord where HD had been performed had a significantly lower total median residual nerve count of 5 (0–10), compared to 8 (2–12) on the non-HD side (p = 0.007). No structural damage was seen in the vessels in the spermatic cord that had undergone HD (gross exam and histology). HD of the spermatic cord significantly decreases residual nerve density without compromising vascular integrity in a rat model.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Costabile RA, Hahn M, McLeod DG. Chronic orchialgia in the pain prone patient: the clinical perspective. J Urol. 1991;146:1571–4.

    Article  CAS  Google Scholar 

  2. Davis BE, Noble MJ, Weigel JW, Foret JD, Mebust WK. Analysis and management of chronic testicular pain. J Urol. 1990;143:936–9.

    Article  CAS  Google Scholar 

  3. Sibert L, Safsaf A, Rigaud J, Delavierre D, Labat JJ. Retentissement sur la sexualite et la fertilite des douleurs pelviperineales chroniques [Impact of chronic pelvic pain on sexual functions and fertility]. Prog Urol. 2010;20:917–21.

    Article  CAS  Google Scholar 

  4. Strom KH, Levine LA. Microsurgical denervation of the spermatic cord for chronic orchialgia: long-term results from a single center. J Urol. 2008;180:949–53.

    Article  Google Scholar 

  5. Parekattil SJ, Gudeloglu A, Brahmbhatt JV, Priola KB, Vieweg J, Allan RW. Trifecta nerve complex—potential anatomic basis for microsurgical denervation of the spermatic cord for chronic orchialgia. J Urol. 2013;190:265–70.

    Article  Google Scholar 

  6. Levine L. Chronic orchialgia: evaluation and discussion of treatment options. Ther. Adv Urol. 2010;2:209–14.

    Article  Google Scholar 

  7. Parekattil SJ, Cohen MS. Robotic surgery in male infertility and chronic orchialgia. Curr Opin Urol. 2010;20:75–9.

    Article  Google Scholar 

  8. Ramasamy R, Sterling J, Li PS, Robinson BD, Parekattil S, Chen J, et al. Multiphoton imaging and laser ablation of rodent spermatic cord nerves: potential treatment for patients with chronic orchialgia. J Urol. 2012;187:733–8.

    Article  Google Scholar 

  9. Menovsky T, De Ridder D. Hydrodissection versus high-pressure water jet dissection. Microsurgery.2007;27:354.

    Article  Google Scholar 

  10. Ting J, Rozen WM, Morsi A. Subfascial variants of the deep inferior epigastric artery and its perforators: use the hydrodissection technique. Microsurgery.2010;30:249–50.

    Article  Google Scholar 

  11. Kumar S, Nair RU. Left anterior descending artery endarterectomy by hydrodissection. Heart Lung Circ. 2009;18:289–92.

    Article  Google Scholar 

  12. Guru KA, Perlmutter AE, Butt ZM, Peabody JO. Hydrodissection for preservation of neurovascular bundle during robot-assisted radical prostatectomy. Can J Urol. 2008;15:4000–3.

    PubMed  Google Scholar 

  13. Aljumaily A, Al-Khazraji HAJ, Gordon A, Lau S, Jarvi KA. Chronic scrotal pain may lead to reduced sexual function and interest, while sexual activity may worsen chronic scrotal pain: “double jeopardy”. Transl Androl Urol. 2018;7 Suppl 1:S23–8.

    Article  Google Scholar 

  14. Alkan I, Yuksel M, Ozveri H, Atalay A, Canat HL, Culha MG, et al. Semen reactive oxygen species levels are correlated with erectile function among chronic prostatitis/chronic pelvic pain syndrome patients. Int J Impot Res. 2018;30:335–41.

    Article  Google Scholar 

  15. Kumar P, Mehta V, Nargund VH. Clinical management of chronic testicular pain. Urol Int. 2010;84:125–31.

    Article  Google Scholar 

  16. Papachristou DN, Barters R. Resection of the liver with a water jet. Br J Surg. 1982;69:93–4.

    Article  CAS  Google Scholar 

  17. Toth S, Vajda J, Pasztor E, Toth Z. Separation of the tumor and brain surface by “water jet” in cases of meningiomas. J Neurooncol. 1987;5:117–24.

    Article  CAS  Google Scholar 

  18. Corvin S, Sturm W, Schlatter E, Anastasiadis A, Kuczyk M, Stenzl A. Laparoscopic retroperitoneal lymph-node dissection with the waterjet is technically feasible and safe in testis-cancer patient. J Endourol. 2005;19:823–6.

    Article  Google Scholar 

  19. Moinzadeh A, Hasan W, Spaliviero M, Finelli A, Kilciler M, Magi-Galluzzi C, et al. Water jet assisted laparoscopic partial nephrectomy without hilar clamping in the calf model. J Urol. 2005;174:317–21.

    Article  Google Scholar 

  20. Patel MI, Spernat D, Lopez-Corona E. Hydrodissection of neurovascular bundles during open radical prostatectomy improves postoperative potency. J Urol. 2011;186:233–7.

    Article  Google Scholar 

  21. Kaduk WM, Stengel B, Pohl A, Nizze H, Gundlach KK. Hydro-jet cutting: a method for selective surgical dissection of nerve tissue. An experimental study on the sciatic nerve of rats. J Craniomaxillofac Surg. 1999;27:327–30.

    Article  CAS  Google Scholar 

  22. Oertel J, Gaab MR, Knapp A, Essig H, Warzok R, Piek J. Water jet dissection in neurosurgery: experimental results in the porcine cadaveric brain. Neurosurgery. 2003;52:153–9.

    PubMed  Google Scholar 

  23. Tschan C, Gaab MR, Krauss JK, Oertel J. Waterjet dissection of the vestibulocochlear nerve: an experimental study. J Neurosurg. 2009;110:656–61.

    Article  Google Scholar 

Download references

Funding

Funding for the animals and instrumentation was provided by ERBE, Inc. All authors have no disclosures.

Author information

Authors and Affiliations

  1. Department of Urology, Hacettepe University Faculty of Medicine, Ankara, Turkey

    Ahmet Gudeloglu

  2. The PUR Clinic, South Lake Hospital, Clermont, FL, USA

    Jamin V. Brahmbhatt & Sijo J. Parekattil

  3. University of Florida, Gainesville, FL, USA

    Robert Allan

Authors
  1. Ahmet Gudeloglu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jamin V. Brahmbhatt
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Robert Allan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sijo J. Parekattil
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ahmet Gudeloglu.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gudeloglu, A., Brahmbhatt, J.V., Allan, R. et al. Hydrodissection for improved microsurgical denervation of the spermatic cord: prospective blinded randomized control trial in a rat model. Int J Impot Res 33, 118–121 (2021). https://doi.org/10.1038/s41443-020-00351-1

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41443-020-00351-1

Search

Advanced search

Quick links