A Superior Spermatic Cord Denervation Technique?: A Meta-Analysis.

In 30 seconds

This systematic review and meta-analysis compared standard, targeted complex, and robotic-assisted spermatic cord denervation for men with chronic orchialgia. Across 23 studies, complete pain resolution was reported in 65.8% of testicular units after standard denervation, 48.6% after targeted denervation, and 51.4% after robotic-assisted denervation. Standard denervation had higher odds of complete pain relief than targeted denervation (OR: 1.86; 95% CI: 1.51-2.29; p < 0.001) and robotic-assisted denervation (OR: 1.68; 95% CI: 1.36-2.07; p < 0.001). Odds of significant (> 50%) pain relief did not differ between approaches.

Key findings

• Complete pain resolution occurred in 65.8% of units after standard, 48.6% after targeted, and 51.4% after robotic-assisted denervation.
• Standard denervation had higher odds of complete relief than targeted denervation (OR: 1.86; 95% CI: 1.51-2.29; p < 0.001) and robotic-assisted denervation (OR: 1.68; 95% CI: 1.36-2.07; p < 0.001).
• Odds of significant (> 50%) pain relief were similar for standard versus targeted (OR: 0.94; 95% CI: 0.72-1.24; p = 0.68) and robotic-assisted denervation (OR: 0.98; 95% CI: 0.74-1.28; p = 0.86).
• Complication rates were similar: 6.1% with standard, 7.0% with targeted, and 7.6% with robotic-assisted denervation.

Why it matters

The findings distinguish complete pain resolution from substantial but incomplete improvement: standard denervation was associated with greater odds of complete relief, while the approaches had similar odds of achieving more than 50% relief. This distinction may help frame discussions of expected outcomes, while the evidence does not establish that one technique is definitively superior.

What to keep in mind

The authors note that a lack of well-designed comparative studies limits efficacy comparisons. Additionally, 55% (12/22) of scored studies had a Newcastle-Ottawa Scale score < 7.