To characterize the effect of microscopic spermatic cord denervation (mSCD) on chronic scrotal content pain (CSCP) after inguinal hernia repair (IHR) and identify factors associated with pain resolution.

We conducted a retrospective chart review of patients who underwent mSCD for CSCP following IHR from January 2018 to June 2024 at a single academic medical center. Patient demographics, medical history, IHR surgical parameters, and postoperative self-reported pain assessments were collected. Patients were categorized as having complete, partial, or no resolution of pain. Univariate regression analysis was performed to identify predictors of pain resolution.

Forty-two patients with CSCP following IHR who underwent mSCD were included. Five patients underwent bilateral mSCD, resulting in 47 cases for analysis. Pain resolved completely in 43% (n = 20/47) and improved in 87% (n = 41/47) of cases as assessed at a median follow-up time of 7 weeks (IQR: 6-14 weeks). No patient factors or IHR operative parameters were associated with complete pain resolution on univariate analysis. Patients who reported no improvement in pain (14%, n = 6/42) were younger (33 vs 58 years, P = .03) and more likely to have a history of levator tenderness/spasm (50 vs 7%, P = .02).

mSCD results in palliation of CSCP in most patients with prior IHR. mSCD may be less likely to benefit younger patients and those with a history of levator tenderness/spasm. General surgeons should consider urologic referral for mSCD in this patient population.