Updated journal articles:
Laparoscopic donor nephrectomy: an increasingly common cause for testicular pain and swelling
M Jalali,1 S Rahmani,1, 2 AD Joyce,1 JJ Cartledge,1 MH Lewis,2 and N Ahmad1
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3954321/CONCLUSIONS: Testicular pain and swelling following LDN is a common problem. It is underreported in the literature and should be included in the differential diagnoses of testicular pain and swelling. Further investigation is required to confirm our findings.
Technical Modification for Laparoscopic Donor Nephrectomy to Minimize Testicular Pain: A Complication with Significant Morbidity
S. P. Shirodkar1, M. A. Gorin1, J. Sageshima2, V. G. Bird1, J. M. Martinez3, A. Zarak2, G. Guerra2, L. Chen2, G. W. Burke2 and G. Ciancio1,2,*
http://onlinelibrary.wiley.com/doi/10.1111/j.1600-6143.2011.03495.x/abstractAbstract: The laparoscopic approach to donor nephrectomy is becoming increasingly common. While it is felt that the recovery from laparoscopic nephrectomy is quicker and less painful, a number of complications have been reported. A rarely reported on complication in the literature with significant morbidity is ipsilateral orchalgia. From 1998 to 2008, 257 hand-assisted laparoscopic donor nephrectomies were performed at our institution. Eight of 129 (6.2%) men complained of de novo ipsilateral orchalgia postoperatively. The average duration of pain was 402 days. Patients reported significant morbidity related to this complication. None, however, required further treatment. Three patients reported that they would reconsider organ donation as a result of testicular pain. Our technique originally included dissection and ligation of the gonadal vein en bloc with the ureter at the level of the left common iliac artery. Since recognizing this complication, we have adopted a gonadal vein sparing approach so as not to disturb the vessel below its point of ligation at the renal vein. To date, 50 patients have undergone the modified technique without experiencing orchalgia. In conclusion, ipsilateral testicular pan is a relatively frequent complication of laparoscopic donor nephrectomy and may be a source of significant morbidity. Using a modified surgical technique, this complication can be reduced or eradicated.
Orchialgia after laproscopic renal surgery: a common problem with questionable etiology. Are there any predictors?
Alok Srivastava, Rakesh Kapoor, Aneesh Srivastava, M. S. Ansari, Manmeet Singh, Rohit Kapoor
http://link.springer.com/article/10.1007%2Fs00345-012-0864-7Conclusion
Ipsilateral orchialgia is common in patients undergoing laproscopic renal surgery specially after radical nephroureterectomy and nephrectomy specially when the ureter and gonadal vein are taken down at or below their crossing of iliac vessels. Taking down ureter above, rather than below, the iliac vessels whenever possible may be preventive as is the preservation of gonadal vein.
Innovations in Organ Donation
Michael J. Goldstein MD1,2,*, Nir Lubezky MD1, Yuriy Yushkov PhD, MBA2, Coney Bae BS3 and James V. Guarrera MD3
http://onlinelibrary.wiley.com/doi/10.1002/msj.21312/abstractTechniques in laparoscopic donor nephrectomy
Neal Banga and David Nicol
http://onlinelibrary.wiley.com/doi/10.1111/j.1464-410X.2012.11058.x/fullNote this was reported earlier, in 2003, too:
Ipsilateral orchialgia after laparoscopic donor nephrectomy.
Kim FJ1, Pinto P, Su LM, Jarrett TW, Rattner LE, Montgomery R, Kavoussi LR.
http://www.ncbi.nlm.nih.gov/pubmed/12965068?dopt=AbstractConclusion: Laparoscopic donor nephrectomy has proven to be an effective and safe surgical procedure. However, further evaluation has demonstrated a complication not previously reported, namely ipsilateral orchialgia. The etiology remains unclear but may be injury to the sensory nerves of the testicle during dissection of the periureteral tissue or transection of the spermatic cord. Further anatomic and physiological studies are needed to elucidate the pathophysiology of this problem.