2025 FSA Podium and Poster Abstracts

INTRODUCTION: Chronic orchialgia (CO), defined as testicular pain lasting more than three months, affects approximately 100,000 men annually in the U.S. Traditional management strategies include conservative therapies and targeted microsurgical denervation of the spermatic cord (TMDSC). However, a significant subset of patients remains refractory to these interventions, necessitating alternative treatments. Given the increasing emphasis on resource optimization throughout medicine and anesthesia, office-based ultrasound-guided peri-spermatic cord and ilioinguinal cryoablation (UTC) presents a novel, minimally invasive solution for chronic pain management. Office-based UTC may eliminate the need for general anesthesia and hospital-based resources, UTC maximizing anesthesia resource allocation. This study will evaluate the technique, feasibility, safety, and efficacy of office-based UTC under IV sedation for CO treatment.

METHODS: This prospective cohort study involved 106 UTC procedures performed on 82 patients between Jan. 2021 and Oct. 2024. All cases were conducted in a single office-based operating room by an experienced surgeon under IV sedation. A Cooper Surgical Cryo Plus Nitrous Gas System was used, administering a single freeze/thaw cycle to reach temperatures of -89°F, guided by real-time ultrasound Doppler imaging. Chronic Orchialgia Symptom Index (COSI) scores were recorded pre- and post-procedure.

RESULTS: In 106 cryoablation cases (82 patients), the mean age was 52 (range: 20-84), with a mean follow-up of 25 months (1 to 45 months). The mean preoperative COSI score was 22, which decreased to 14 postoperatively. Overall, 76% of patients reported significant pain relief. Complications included localized wound infection in 3 patients (3.6%).

DISCUSSION/CONCLUSIONS: As chronic pain management is a core domain of anesthesiology, optimization and efficacy of many noninvasive therapies is of significant interest. This study suggests office-based ultrasound-guided peri-spermatic cord and ilioinguinal cryoablation is a safe, feasible, and potentially effective salvage treatment option for chronic orchialgia. This technique provides targeted pain relief while broadening the scope of anesthetic pain management strategies. This minimally invasive approach can improve quality of life in up to 76% of carefully selected patients while reducing health care costs as an officed based procedure. Larger cohort studies with extended follow-up are necessary to further evaluate the long-term durability of this procedure.