To examine the utility of a modified spermatic cord block (MSCB) that targets known contributors to refractory chronic scrotal content pain (CSCP) at predicting postoperative pain relief following a microscopic spermatic cord denervation (MSCD).

A MSCB was performed in all patients with refractory CSCP. This was performed by injecting anesthetic circumferentially around the vas deferens and over the external ring. Patients with >50% pain reduction were offered MSCD. Baseline, post-block, and postoperative pain was assessed. Age, prior groin surgery, and post-block pain free period were recorded. A multivariate linear regression model was used to determine predictors of surgical success.

Fifty-two patients underwent a MSCB. Forty-six (88%) had an adequate response and underwent MSCD. All patients saw improvement in pain postoperatively with an average reduction of 80% (4 < 50%; 7 50-69%; 35   70%). On multivariate linear regression analysis, pain reduction following MSCD was an independent predictor of postoperative improvement (P < 0.001). No other factors, including post-block pain free period or prior surgery predicted success.

The described MSCB can be utilized as an independent predictor of success following MSCD. Post-block pain free period was not associated with postoperative pain level. The MSCB may help identify candidates for MSCD that would be missed with the traditional block.