Gjertson CK and Sundaram CP (2008) Testicular pain following laparoscopic renal surgery. J Urol 180: 2037–2040

Testicular pain has been reported as a potential adverse effect of laparoscopic renal surgery, but is generally only identified after direct questioning. Gjertson and Sundaram, therefore, prospectively studied male patients scheduled for laparoscopic kidney and adrenal surgery to determine the incidence of testicular pain postsurgery.

The researchers assessed 64 men (mean age 50years) in which a total of 68 procedures (60 unilateral, 4 bilateral) were carried out. Initial postoperative physical examination revealed no changes from baseline, and no patient described testicular pain. After discharge from the hospital, 14 patients developed testicular pain (4–7days after surgery), which was ipsilateral to the surgical side in 13 cases. All patients reporting pain underwent either donor nephrectomy or radical nephrectomy. These men were a mean 10years younger, had an increased intraoperative urine output, and were less likely to have a history of surgery, than those who experienced no pain. However, the authors were unsure whether these factors were linked to testicular pain or reflected the limited cohort size. Instead, they explained that ligation of the gonadal vein seemed to be associated with the risk of pain: testicular pain developed after 13 (33%) of the 39 procedures where the gonadal vein was ligated, compared with just 1 case when the gonadal vein was preserved (3.4% of 29 procedures).

The authors suggest that patients undergoing donor or radical nephrectomy should be informed of the potential for testicular pain, and that preservation of the gonadal vein might confer a protective effect.