The Role of Peripheral Nerve Surgery in the Treatment of Testicular and Groin Pain

Ivica Ducic*
Georgetown University Hospital, Washington, DC

Introduction:The neuropathic groin pain after inguinal hernia repair is usually due to a neuroma of the ilioinguinal, iliohypogastric, or genitofemoral nerve. When the post-herniorrhaphy pain symptoms include mostly testicular pain, then the genital branch of the genitofemoral nerve comes first in the differential diagnosis. Nerve blocks, although helpful in determining which of the three nerves is/are implicated in the pain syndrome, are not sensitive.
Methods: Anatomical cadaver dissections of nerves exiting the lumbosacral plexus were performed. Their course was followed to their final terminations. Based on these findings, an operative approach was designed to address the involved nerve at a specific site. The results and outcome of patients that underwent herniorrhaphy or urologic procedures were prospectively followed.
Results: The present anatomic study identifies the site within the inguinal canal where the genital branch of the genitofemoral nerve may be identified. The designed operative approach points to the proximal site of the canal to be opened for an exposure. It also dictates that the nerve should be dissected and resected proximal to the surgical repair or mesh reconstruction, which allows its retroperitoneal placement. Utilizing this approach, 15 of 20 (75%) patients were completely relieved of their pre-operative symptoms, 3 (15%) had 60-70% pain reduction, but remained with groin discomfort, and 2 (10%) were failures since no improvement was made.
Conclusions:Severe and chronic testicular pain after inguinal hernia repair or prior testicular surgery can successfully be treated by a designed approach.

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