A case of scrotal pain associated with genitofemoral nerve injury following cystectomy.

The genitofemoral neuropathy is one of the most common causes of groin pain after surgery. Especially, the groin pain induced by genitofemoral nerve injury during herniorrhaphy is a well-known complication. In contrast, much attention is not paid for groin pain induced by genitofemoral nerve injury after pelvic surgery, and there have been few reports in males, although it has been reported in females. We report a 59-year-old male patient who suffered from scrotal pain caused by presumed genitofemoral nerve injury during radical cystectomy and bilateral pelvic lymphadenectomy for bladder cancer. The surgical procedure was performed in a supine position under general anesthesia, without epidural anesthesia. Postoperatively, he complained of burning and lancinating pain in bilateral scrotal area. Abnormal findings were not evident using computed tomography and ultrasonography of the pelvis, including the scrotum and testicles. He had severe allodynia of the ventral scrotum and bilateral ventromedial thigh region, with absence of cremasteric reflex. We speculated that his pain might have been surgery-induced genitofemoral neuropathy, which was caused by nerve injury during lymphadenectomy near the external iliac vessels. His scrotal pain and allodynia following the cystectomy were partially and gradually relieved after administering pregabalin, further supporting the contention that his scrotal pain was a surgery-induced neuropathy.