cornellbrady1's video: Microsurgical Denervation of Rat Spermatic Cord: Safety and Efficacy Data

This video presented by Melissa A. Laudano, E. Charles Osterberg, Seema Sheth, Ranjith Ramasamy, Joshua Sterling, Sushmita Mukherjee, Brian D. Robinson, Sijo Parekattil, Marc Goldstein, Philip S. Li, and Peter N. Schlegel The video was produced at Department of Urology, Center for Male Reproductive Medicine and Microsurgery, Weill Cornell Medical College, New York Presbyterian Hospital. Cornell Brady Urology Studio Production 2012. ( 2013 AUA Best Video ( 3rd Prize) www.cornellurology.com; www.maleinfertility.org Chronic orchialgia is a common urologic complaint, however, there is no established treatment for patients who have failed medical management. Spermatic cord denervation has been proposed, but intraoperative identification of nerves is difficult and there is a risk vascular and vasal injury. The objectives of this study are: 1) describe a microsurgical technique for denervation of the spermatic cord, 2) use multiphoton microscopy (MPM) to identify and ablate residual nerves after microsurgical denervation 3) evaluate for postoperative changes is in testicular and vasal structure and function. Methods: Nine Sprague-Dawley rats were divided into 3 experimental groups: sham, microsurgical denervation alone, and microsurgical denervation plus ablation of residual nerves with MPM. Three rats in the denervation plus MPM group were imaged immediately following denervation, and residual nerves were identified and laser ablated. A post-surgical evaluation was performed on all rats 2 months after the initial surgery. Post-surgical evaluation included: testicular volume measurements, testicular artery identification with doppler, vasal patency testing, and histologic evaluation of the testicle and vas deferens. Results: In the entire cohort, mean testicular volume was 3.1( 0.31)cm3, spermatic cord diameter was 6( 0.6)mm, and vas diameter was 3( 0.3)mm. A 5mm segment was denervated. A pre and post-procedure testicular artery pulse was confirmed with doppler in all rats. In the 3 rats that underwent MPM immediately following denervation, 2 additional nerves were identified and ablated in each rat. On post-surgical evaluation, there was no difference in mean testicular volume among the 3 experimental groups (p=0.71). A doppler pulse was present bilaterally in all rats. In one sham and one denervation alone rat, motile sperm were absent in vasal fluid unilaterally. Vasograms were preformed in these rats and demonstrated patency of the vas deferens. Histologically, there was no difference in testicular architecture among the groups. A microsurgical approach can be used to effectively denervate the rodent spermatic cord with minimal changes to testicular structure and function. Multiphoton microscopy can be used as an adjunct to identify and ablate residual nerves following microsurgical denervation.