Microsurgical spermatic cord denervation is a surgical treatment for selected men with unilateral chronic testicular or scrotal pain (chronic orchialgia) that persists despite conservative treatment, and responds positively to spermatic cord block in the office, and when other causes of pain have been excluded or appropriately treated.

The procedure involves identifying and selectively dividing small nerve fibers within the spermatic cord while preserving the testicular artery, vas deferens, lymphatics, and other critical structures. A successful diagnostic response to a targeted spermatic cord block can help identify men who are most likely to benefit.

In appropriately selected patients, studies report meaningful or complete pain improvement in approximately 70–90% of men, although outcomes vary and surgery cannot guarantee complete resolution of chronic pain. Importantly, as with all surgeries for pain, there is a ~10% chance that pain can worsen after surgery.

The procedure is generally outpatient. Most patients experience postoperative soreness for several days and gradually return to normal activities over 1–2 weeks. Risks include persistent or recurrent pain, numbness, infection, bleeding, hydrocele, and, rarely, injury to the testicular blood supply.