Procedures
Infiltration of the Spermatic Cord
The technique consists in infiltrating the spermatic cord, as high as possible as soon as it leaves the inguinal canal, with a long-acting non-adrenaline local anaesthetic. It allows evaluating the analgesic effect on a scrotal pain.
Spermatic cord block is effective when spontaneous scrotal pain (without pressure) and pain triggered by palpation of the epididymis or testicle disappear during local anaesthesia.
When a spermatic cord block is effective, it validates that the pain comes from the scrotal area., If the cord block, properly performed, is not effective since the pain is persistent, it is necessary to move towards a referred pain higher height the inguinal region. It can then be a pain whose origin is located either on the course of the ilioinguinal or genito-femoral nerves or at the lumbar level around L1.
There is no consensus protocol for infiltration repetition that has been validated consensually in the literature. The spermatic bloc can be realized in one of our clinics. They are repeated in case of success associated with injectable cortisone. The frequency of cord infiltration is according to the duration of the pain improvement period.
- We recommend treating the affected area for the first 48 hours with ice (gel or pea bag, wrapped in wet towel) for 15-minutes and repeated every 2-3 hours during the day. This reduces postoperative edema and discomfort in the days that follow.
- We also recommend taking Tylenol regulary every 4 hours during the first day, and avoid Advil brand medications or other anti-inflammatory drugs that may increase the risk of bleeding.
- A shower is allowed after 24 hours.
- Do not perform any physical, sexual or athletic efforts for the first 48 hours.
Who are the candidates for an infiltration of the spermatic cord?
Patients who suffer from chronic and persistent scrotal pain. These patients usually have a chronic epididymitis that is uncomfortable. These patients are sometimes little relieved by medical treatments.
When to use this treatment?
It is proposed in case of failure of medical treatments. This is a simple procedure of a few minutes for diagnostic purposes, but also therapeutic.
How is a spermatic cord bloc is performed?
Anaesthetic cream is applied to the inguinal area. This procedure is usually performed under local anaesthesia. It is initially performed by an injector that sends anaesthetic liquid under high pressure through the skin. You will feel rather a pinch sensation like a blow of an elastic band. Then, the infiltration of the cord at the level of the epididymitis and the subcutaneous tissue is no longer felt. It is performed under ultrasound guidance. It lasts about ten minutes.