For men with chronic testicular pain that hasn’t responded to medication, nerve blocks, or other conservative care, surgery can feel like a daunting last resort. Microsurgical spermatic cord denervation is one of the most effective surgical options — a precise, nerve-sparing procedure that removes the pain-carrying nerves of the spermatic cord while preserving the structures responsible for blood flow, hormone delivery, and fertility. For carefully selected men, it can mean lasting relief after years of frustration.
Dr. Justin Houman is a board-certified urologist and Fellow of the American College of Surgeons, fellowship-trained in male reproductive medicine and microsurgery at UCLA and an Assistant Professor of Urology at Cedars-Sinai Medical Center. His practice — a designated Center of Excellence for Testicular Pain and Orchialgia — has performed more than 1,000 microsurgical denervations for men with complex and previously unresolved pain, primarily using the open microsurgical technique that remains the gold standard for this procedure. For select patients, he also offers a robotic-assisted approach.
I had an excellent experience with Dr. Justin Houman, who is truly an expert in male fertility. He took the time to listen carefully and explain all the available options in a way that was easy to understand. His approach is compassionate, professional, and very thorough. I felt confident knowing I was in the care of someone highly specialized in men’s reproductive health. If you are looking for a knowledgeable and caring physician to help with male fertility concerns, I highly recommend Dr. Houman.
What Is Microsurgical Spermatic Cord Denervation?
Microsurgical spermatic cord denervation is a precise surgical technique that treats chronic testicular pain at its source. Using an operating microscope, Dr. Houman identifies and selectively interrupts the nerve fibers within the spermatic cord that transmit pain, while carefully preserving the structures responsible for blood flow, hormone delivery, and fertility. The goal is to relieve or eliminate pain in appropriate candidates without sacrificing the testicle or its normal function. This open microsurgical technique is the approach Dr. Houman uses for the large majority of his denervation patients.
Why Microsurgical Precision Matters
Performing this delicate nerve work under high-powered microscopic magnification allows for exacting, selective treatment of only the nerves responsible for pain:
Enhanced Precision
High-powered magnification through the operating microscope allows for millimeter-level precision that the naked eye cannot achieve.
Structure Preservation
Targeting only the pain-carrying nerves helps protect the testicular artery, vas deferens, and lymphatic channels.
Minimally Invasive
Small incisions mean less scarring and a typically faster, more comfortable recovery.
Selective Nerve Targeting
Only the nerves responsible for pain are interrupted, preserving normal blood flow and function.
Who Is a Candidate?
Microsurgical denervation is not the first step for testicular pain, and it isn’t right for everyone. The strongest candidates share a clear, nerve-related picture:
- Chronic testicular pain lasting more than three months
- Pain that has not responded to conservative treatments such as medication, nerve blocks, or physical therapy
- Post-vasectomy pain syndrome with persistent, nerve-related discomfort
- Temporary relief from a diagnostic spermatic cord block, which is the single strongest predictor of surgical success
- No other identifiable or reversible cause found on urologic workup
What to Expect: Procedure and Recovery
Microsurgical spermatic cord denervation is performed on an outpatient basis and takes approximately one hour, allowing most men to return home the same day. Recovery is generally quick, with a return to normal activities within three to seven days. Because the technique is nerve-sparing, sexual function and fertility are preserved. In carefully selected patients, published studies report long-term pain relief in roughly 80 to 90 percent — though individual results vary and depend heavily on proper candidate selection. Recovery is an important part of a successful outcome, and for a complete, stage-by-stage walkthrough, see:
Frequently Asked Questions About Microsurgical Spermatic Cord Denervation
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Dr. Houman performs the large majority of denervation procedures using the open microsurgical technique, which remains the gold standard. For select patients, he also offers a robotic-assisted approach using the da Vinci platform for enhanced magnification and precision.
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The strongest candidates have chronic pain lasting more than three months, have failed conservative treatments, have no other reversible cause, and — most importantly — experienced temporary relief from a diagnostic spermatic cord block.
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In carefully selected patients, published studies report long-term pain relief in roughly 80 to 90 percent, though individual results vary and depend heavily on proper selection.
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No — the procedure is nerve-sparing and preserves the blood supply and the vas deferens, so sexual function and fertility are maintained.
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The outpatient procedure takes about an hour, and most men return to normal activities within three to seven days. The complete recovery guide covers each stage in detail.
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No — denervation preserves the testicle entirely and interrupts only the pain-transmitting nerves; testicle removal is considered only as a rare last resort.
Why Patients Choose Dr. Houman for Microsurgical Denervation
- Microsurgical Expertise: Fellowship-trained in the open microsurgical technique that remains the gold standard, with a robotic-assisted option also available.
- Selection-First Philosophy: Diagnostic cord blocks confirm candidacy before any surgery is recommended.
- Function-Preserving Technique: Nerve-sparing precision protects fertility, hormones, and blood flow.
- High Surgical Volume: Extensive experience across more than 1,000 microsurgical denervation procedures.
Meet Dr. Houman
Expert in Men’s Health with Tower Urology and Cedars Sinai
Dr. Justin Houman, MD, FACS is a board-certified urologist and fellowship-trained microsurgeon at Tower Urology, Cedars-Sinai Medical Center in Los Angeles. His subspecialty training in male reproductive medicine and microsurgery is held by fewer than 2% of practicing urologists in the United States.
His clinical focus is narrow by design. Varicoceles, chronic testicular pain, male infertility, vasectomy, testosterone optimization, erectile dysfunction, penile implant surgery, and Peyronie’s disease are not add-on services here. They are the practice. Patients travel from across the country and internationally for procedures, particularly microsurgical varicocelectomy, spermatic cord denervation, and inflatable penile implant surgery, that require a level of subspecialty training and surgical volume most urology practices do not have.
Microsurgical Denervation Surgery in Los Angeles
Chronic testicular pain is not something you simply have to live with, and when conservative treatments fall short, a precise, nerve-sparing approach can change everything. Dr. Houman offers microsurgical spermatic cord denervation for carefully selected men across Los Angeles and Southern California, with honest guidance about whether the procedure is right for you. Contact the Los Angeles office to schedule a consultation and learn whether microsurgical denervation could finally bring you relief.
