Email Alert | RSS

Journal of Peking University (Health Sciences) ›› 2024, Vol. 56 ›› Issue (4): 646-655. doi: 10.19723/j.issn.1671-167X.2024.04.017

Previous Articles     Next Articles

Construction of a predictive model for postoperative pain relief after microscopic spermatic cord surgery for spermatic cord pain

Hailong HE,Qing LI,Tao XU,Xiaowei ZHANG*()   

  1. Department of Urology, Peking University People' s Hospital; The Institute of Applied Lithotripsy Technology, Peking University, Beijing 100044, China
  • Received:2024-03-12 Online:2024-08-18 Published:2024-07-23
  • Contact: Xiaowei ZHANG E-mail:docachang@126.com
  • Supported by:
    the Beijing Natural Science Foundation(7194327)

RICH HTML

   

PDF (PC)

Abstract:

Objective: To explore the relevant factors affecting the efficacy of microscopic spermatic cord surgery and build a predictive model for postoperative pain relief. Methods: A retrospective analysis was conducted on the clinical data of 324 patients with spermatic cord pain who visited the Department of Urology at Peking University People's Hospital between October 2015 and April 2023. This cohort included 212 patients with varicocele-related spermatic cord pain and 112 patients with idiopathic spermatic cord pain. All the patients underwent microsurgical procedures: varicocele-related pain was treated with microsurgical varicocelectomy, and idiopathic pain was treated with microsurgical denervation of the spermatic cord. The patients were categorized into effective and ineffective groups based on whether their pain had decreased by more than 50% six months post-surgery compared with pre-surgery levels. Baseline data were preliminarily screened for clinical indicators using t tests and univariate analysis. Clinical predictor variables [age, duration of pain, diameter of varicocele, patient health questionnaire-9 (PHQ-9) score, generalized anxiety disorder-7 (GAD-7) score] were selected using Lasso regression. A clinical prediction model for effective pain relief following microscopic spermatic cord surgery was constructed using Logistic regression and presented as a nomogram. The model's internal validation was performed using the bootstrap method. Its predictive power and clinical utility were evaluated through the concor-dance index, the area under the receiver operating characteristic curve, and calibration plots. Results: Post-microscopic varicocele ligation, 156 patients (73.58%) experienced significant pain relief, as did 94 patients (83.93%) following microscopic denervation. Independent predictors for postoperative outcomes included age, PHQ-9 score, GAD-7 score, chronic pain duration, and varicocele diameter, differing slightly between varicocele-related and idiopathic pain groups. The models demonstrated excellent predictive ability, with areas under the curve of 0.909 and 0.913 for varicocele and idiopathic groups, respectively, and high concordance indices. Conclusion: The postoperative efficacy prediction model based on age, pain duration, PHQ-9 score, GAD-7 score, and varicocele diameter has good predictive ability and clinical applicability, and can be used in clinical practice.

Key words: Spermatic cord, Pain, Varicocele, Denervation, Predictive model

CLC Number: 

  • R697.24

Figure 1

Lasso regression coefficient penalty plot for the varicocele-related spermatic cord pain group"

Table 1

Multivariate analysis results of factors influencing pain relief after microscopic varicocele ligation"

Influencing factors Regression coefficient Standard error Z P OR OR (95%CI)
Age/years 0.078 0.024 3.240 0.001 1.081 1.033-1.137
Pain course time/months 0.071 0.022 3.080 0.002 1.070 1.029-1.127
PHQ-9 -0.100 0.080 -1.229 0.040 0.906 0.768-1.048
GAD-7 -0.275 0.092 -2.990 0.003 0.759 0.627-0.900
Varicocele vein diameter/mm -1.897 0.346 -5.476 < 0.001 0.150 0.072-0.282
Intercept 3.875 1.415 2.737 0.006 48.175 3.331-894.121

Figure 2

Lasso regression coefficient penalty plot for the idiopathic spermatic cord pain group"

Table 2

Multivariate analysis results of factors influencing pain relief after microscopic denervation of the spermatic cord"

Influencing factors Regression coefficient Standard error Z P OR OR (95%CI)
Age/years 0.088 0.030 2.932 0.003 1.092 1.033-1.163
Pain course time/months -0.078 0.026 -3.039 0.002 0.925 0.876-0.971
PHQ-9 -0.178 0.074 -2.418 0.016 0.837 0.717-0.959
GAD-7 -0.242 0.090 -2.700 0.007 0.785 0.648-0.922
Intercept 2.829 1.508 1.876 0.061 16.930 1.025-420.954

Figure 3

Nomogram model for the patients with varicocele-related spermatic cord pain PHQ-9, patient health questionnaire-9; GAD-7, generalized anxiety disorder-7."

Figure 4

Nomogram model for the patients with idiopathic spermatic cord pain PHQ-9, patient health questionnaire-9; GAD-7, generalized anxiety disorder-7."

Table 3

Evaluation of the predictive model's efficacy for varicocele-related spermatic cord pain (n=212)"

Influencing factors AUC value Sensitivity Specificity Youden index Cut off
Prediction model 0.909 0.882 0.833 0.715 0.645
Age/years 0.684 0.546 0.900 0.446 46.000
Time of pain course/months 0.723 0.849 0.550 0.399 17.000
PHQ-9 0.702 0.683 0.658 0.341 5.000
Varicocele vein diameter/mm 0.769 0.783 0.678 0.461 3.000
GAD-7 0.763 0.867 0.612 0.479 4.000

Figure 5

ROC of the predictive model for varicocele-related spermatic cord pain AUC, area under curve; ROC, receiver operating characteristic."

Figure 6

Individual ROC for each factor of the predictive model for varicocele-related spermatic cord pain AUC, area under curve; ROC, receiver operating characteristic; PHQ-9, patient health questionnaire-9; GAD-7, generalized anxiety disorder-7."

Table 4

Evaluation of the predictive model's efficacy for idiopathic spermatic cord pain (n=112)"

Influencing factors AUC value Sensitivity Specificity Youden index Cut off
Prediction model 0.913 0.863 0.906 0.769 0.734
Age/years 0.772 0.650 0.844 0.494 43.000
Pain course time/months 0.794 0.844 0.600 0.444 24.000
PHQ-9 0.850 0.906 0.625 0.531 6.000
GAD-7 0.738 0.813 0.713 0.525 7.000

Figure 7

ROC of the predictive model for idiopathic spermatic cord pain AUC, area under curve; ROC, receiver operating characteristic."

Figure 8

Individual ROC for each factor in the predictive model for idiopathic spermatic cord pain AUC, area under curve; ROC, receiver operating characteristic; PHQ-9, patient health questionnaire-9; GAD-7, generalized anxiety disorder-7."

1 Basal S , Ergin A , Yildirim I , et al. A novel treatment of chronic orchialgia[J]. J Androl, 2012, 33 (1): 22- 26.
doi: 10.2164/jandrol.110.010991
2 Calixte N , Brahmbhatt J , Parekattil S . Genital pain: Algorithm for management[J]. Transl Androl Urol, 2017, 6 (2): 252- 257.
doi: 10.21037/tau.2017.03.03
3 Ziegelmann MJ , Farrell MR , Levine LA . Evaluation and management of chronic scrotal content pain: A common yet poorly understood condition[J]. Rev Urol, 2019, 21 (2/3): 74- 84.
4 Rottenstreich M , Glick Y , Gofrit ON . Chronic scrotal pain in young adults[J]. BMC Res Notes, 2017, 10 (1): 241.
doi: 10.1186/s13104-017-2590-0
5 Wu C , Jarvi K . Chronic scrotal pain[J]. Curr Urol Rep, 2018, 19 (8): 59.
doi: 10.1007/s11934-018-0811-2
6 Shridharani A , Lockwood G , Sandlow J . Varicocelectomy in the treatment of testicular pain: A review[J]. Curr Opin Urol, 2012, 22 (6): 499- 506.
doi: 10.1097/MOU.0b013e328358f69f
7 Lomboy JR , Coward RM . The varicocele: Clinical presentation, evaluation, and surgical management[J]. Semin Intervent Radiol, 2016, 33 (3): 163- 169.
doi: 10.1055/s-0036-1586143
8 Baigorri BF , Dixon RG . Varicocele: A review[J]. Semin Intervent Radiol, 2016, 33 (3): 170- 176.
doi: 10.1055/s-0036-1586147
9 Dewitt-Foy ME , Nickel JC , Shoskes DA . Management of chronic prostatitis/chronic pelvic pain syndrome[J]. Eur Urol Focus, 2019, 5 (1): 2- 4.
doi: 10.1016/j.euf.2018.08.027
10 Zorn BH , Watson LR , Steers WD . Nerves from pelvic plexus contribute to chronic orchidalgia[J]. Lancet, 1994, 343 (8906): 1161.
doi: 10.1016/S0140-6736(94)90266-6
11 Patel AP . Anatomy and physiology of chronic scrotal pain[J]. Transl Androl Urol, 2017, 6 (Suppl 1): S51- S56.
12 Yi S , Tang X , Yu J , et al. Microarray and qPCR analyses of Wallerian degeneration in rat sciatic nerves[J]. Front Cell Neurosci, 2017, 11, 22.
13 Hunter CW , Stovall B , Chen G , et al. Anatomy, pathophysiology and interventional therapies for chronic pelvic pain: A review[J]. Pain Physician, 2018, 21 (2): 147- 167.
14 Parekattil SJ , Gudeloglu A , Brahmbhatt JV , et al. Trifecta nerve complex: potential anatomical basis for microsurgical denervation of the spermatic cord for chronic orchialgia[J]. J Urol, 2013, 190 (1): 265- 270.
doi: 10.1016/j.juro.2013.01.045
15 Zhuang J , Zhou M , Liao W , et al. Microvascular Doppler assisted microsurgical denervation of the spermatic cord in treating chronic orchialgia[J]. J Vis Exp, 2022, 25, 183.
16 Sun HH , Tay KS , Jesse E , et al. Microsurgical denervation of the spermatic cord: A historical perspective and recent developments[J]. Sex Med Rev, 2022, 10 (4): 791- 799.
doi: 10.1016/j.sxmr.2021.11.005
17 Calixte N , Kartal IG , Tojuola B , et al. Salvage ultrasound-guided targeted cryoablation of the perispermatic cord for persistent chro-nic scrotal content pain after microsurgical denervation of the spermatic cord[J]. Urology, 2019, 130, 181- 185.
doi: 10.1016/j.urology.2019.04.027
18 Ho KY , Gwee KA , Cheng YK , et al. Nonsteroidal anti-inflammatory drugs in chronic pain: Implications of new data for clinical practice[J]. J Pain Res, 2018, 11, 1937- 1948.
doi: 10.2147/JPR.S168188
19 Long H , Bai W , Zhang X , et al. A clinical study on microsurgical denervation of spermatic cord for refractory chronic orchialgia[J]. Urol Int, 2019, 103 (1): 62- 67.
doi: 10.1159/000497281
20 Chaudhari R , Sharma S , Khant S , et al. Microsurgical denervation of spermatic cord for chronic idiopathic orchialgia: Long-term results from an institutional experience[J]. World J Mens Health, 2019, 37 (1): 78- 84.
doi: 10.5534/wjmh.180035
21 Choi Y , Mayer TG , Williams MJ , et al. What is the best scree-ning test for depression in chronic spinal pain patients?[J]. Spine J, 2014, 14 (7): 1175- 1182.
doi: 10.1016/j.spinee.2013.10.037
22 Kroenke K , Spitzer RL , Williams JB , et al. The patient health questionnaire somatic, anxiety, and depressive symptom scales: A systematic review[J]. Gen Hosp Psychiatry, 2010, 32 (4): 345- 359.
doi: 10.1016/j.genhosppsych.2010.03.006
23 Cavalheiro LM , Gil JA , Goncalves RS , et al. Measuring the pain impact in adults with a chronic pain condition: Adaptation and validation of the pain impact questionnaire (PIQ-6) to the Portuguese culture[J]. Pain Med, 2011, 12 (10): 1538- 1543.
doi: 10.1111/j.1526-4637.2011.01222.x
24 Park HJ , Lee SS , Park NC . Predictors of pain resolution after varicocelectomy for painful varicocele[J]. Asian J Androl, 2011, 13 (5): 754- 758.
doi: 10.1038/aja.2010.87
25 Punjani N , Wald G , Gaffney CD , et al. Predictors of varicocele-associated pain and its impact on semen parameters following microsurgical repair[J]. Andrologia, 2021, 53 (8): e14121.
26 Abd Ellatif ME , Asker W , Abbas A , et al. Varicocelectomy to treat pain, and predictors of success: A prospective study[J]. Curr Urol, 2012, 6 (1): 33- 36.
doi: 10.1159/000338867
27 Yaman O , Ozdiler E , Anafarta K , et al. Effect of microsurgical subinguinal varicocele ligation to treat pain[J]. Urology, 2000, 55 (1): 107- 108.
doi: 10.1016/S0090-4295(99)00374-X
28 Al-Gadheeb A , El-Tholoth HS , Albalawi A , et al. Microscopic subinguinal varicocelectomy for testicular pain: A retrospective study on outcomes and predictors of pain relief[J]. Basic Clin Androl, 2021, 31 (1): 1.
doi: 10.1186/s12610-020-00119-z
29 Wilcox SL , Redmond S , Davis TL . Genital image, sexual anxiety, and erectile dysfunction among young male military personnel[J]. J Sex Med, 2015, 12 (6): 1389- 1397.
doi: 10.1111/jsm.12880
30 Hooten WM . Chronic pain and mental health disorders: Shared neural mechanisms, epidemiology, and treatment[J]. Mayo Clin Proc, 2016, 91 (7): 955- 970.
doi: 10.1016/j.mayocp.2016.04.029
31 Van Oudenhove L , Törnblom H , Störsrud S , et al. Depression and somatization are associated with increased postprandial symptoms in patients with irritable bowel syndrome[J]. Gastroenterology, 2016, 150 (4): 866- 874.
doi: 10.1053/j.gastro.2015.11.010
32 Kim HT , Song PH , Moon KH . Microsurgical ligation for painful varicocele: Effectiveness and predictors of pain resolution[J]. Yonsei Med J, 2012, 53 (1): 145- 150.
doi: 10.3349/ymj.2012.53.1.145
33 Clemens JQ , Mullins C , Ackerman AL , et al. Urologic chronic pelvic pain syndrome: Insights from the MAPP Research Network[J]. Nat Rev Urol, 2019, 16 (3): 187- 200.
doi: 10.1038/s41585-018-0135-5
[1] Nannan WANG, Dajin YUAN, Yubing ZHU, Lei DING. Development and validation of a multicenter nomogram predicting the risk of liver metastasis after curative resection of colorectal cancer [J]. Journal of Peking University (Health Sciences), 2026, 58(2): 290-300.
[2] Huili LIU, Bei WEN, Xue BAI, Ming'an CHEN, Min LI. Association between weight-adjusted waist index and pain: A cross-sectional study [J]. Journal of Peking University (Health Sciences), 2025, 57(1): 178-184.
[3] Meijuan LONG, Yidan WANG, Shiya WU, Zihao LI, Yanting LI, Yang LI, Juan JIAO. Effects of overweight and obesity on symptoms, overall condition and quality of life in patients with fibromyalgia syndrome [J]. Journal of Peking University (Health Sciences), 2024, 56(6): 1001-1008.
[4] Jiayu ZHAI, Jinxia ZHAO, Zhuo AN, Rui LIU. Assessment of residual symptoms in patients with axial spondyloarthritis with low disease activity and analysis of its related factors [J]. Journal of Peking University (Health Sciences), 2024, 56(6): 987-993.
[5] Hanwei KE, Qi WANG, Kexin XU. Optimization study of an animal model for interstitial cystitis/bladder pain syndrome based on the dose effect of cyclophosphamide [J]. Journal of Peking University (Health Sciences), 2024, 56(5): 908-912.
[6] Silan AN,Qunyi ZHENG,Kai WANG,Shan GAO. Characteristics and influencing factors of early pain in patients after total knee arthroplasty [J]. Journal of Peking University (Health Sciences), 2024, 56(1): 167-173.
[7] Hui-li LIU,Yan-han LV,Xiao-xiao WANG,Min LI. Factors influencing the chronic post-surgical pain after laparoscopic surgery for elderly patients with urinary tract tumors [J]. Journal of Peking University (Health Sciences), 2023, 55(5): 851-856.
[8] Ci TIAN,Yi BAI,Qing-bian MA,Hong-xia GE. Clinical characteristics of 7 cases of hepatic portal venous gas [J]. Journal of Peking University (Health Sciences), 2023, 55(4): 743-747.
[9] Zhan-peng SHANG,Yang YI,Rong YU,Jing-jing FAN,Yu-xi HUANG,Xue QIAO,Min YE. Bioactive compounds of Jingfang Granules against SARS-CoV-2 virus proteases 3CLpro and PLpro [J]. Journal of Peking University (Health Sciences), 2022, 54(5): 907-919.
[10] Lin ZHU,Wei-yu ZHANG,Ke-xin XU. Urodynamic and histological evaluation of cyclophosphamide-induced bladder pain syndrome in SD rats [J]. Journal of Peking University (Health Sciences), 2022, 54(4): 735-740.
[11] PENG Jing,FANG Dong,ZHANG Zhi-chao,GAO Bing,YUAN Yi-ming,TANG Yuan,SONG Wei-dong,CUI Wan-shou. Testosterone levels in patients with varicocele and azoospermia [J]. Journal of Peking University (Health Sciences), 2022, 54(2): 294-298.
[12] Jing-xian ZHU,Sheng-nan LU,Yan-fang JIANG,Ling JIANG,Jian-quan WANG. Influencing factors of preoperative pulmonary function in elderly patients undergoing rotator cuff surgery [J]. Journal of Peking University (Health Sciences), 2021, 53(5): 902-906.
[13] Peng ZHANG,Bo JIA,Xiao-kun CHEN,Yu WANG,Wei HUANG,Ren-jie LAI,Zhi-wei WANG,Jian XIONG,Tian-bing WANG. Effects of ulnar styloid and sigmoid notch fractures on postoperative wrist function of patients with distal radius fracture [J]. Journal of Peking University (Health Sciences), 2020, 52(3): 578-581.
[14] Duan YI,Wei ZHU,Xiu-li MENG,Xiao-guang LIU,Shui-qing LI,Bin ZHU,Dong-lin JIA. Analysis of anxiety, depression and related factors in patients with chronic lumbocrural pain before minimally invasive surgery [J]. Journal of Peking University (Health Sciences), 2020, 52(2): 285-289.
[15] Shan-shan BAI,Si-yi MO,Xiao-xiang XU,Yun LIU,Qiu-fei XIE,Ye CAO. Characteristics of orofacial operant test for orofacial pain sensitivity caused by occlusal interference in rats [J]. Journal of Peking University(Health Sciences), 2020, 52(1): 51-57.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
No Suggested Reading articles found!
Copyright © Journal of Peking University (Health Sciences), All Rights Reserved.
Powered by Beijing Magtech Co. Ltd