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Urology/Spermatic cord surgery

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Question
Hello Dr., hope your weekend is going well. I just had a quick follow up on your final answer in this thread

http://www.allexperts.com/user.cgi?m=6&catID=989&expID=46720&qID=5103895

You mentioned that the ilioinguinal and genitofemoral nerves were not likely to be involved in that location. However, I noticed that operation report stated that "internal spermatic fascia" was divided. I have read that the genital branch of the genitofemoral nerve is contained inside the spermatic cord, so wouldn't that mean that this nerve was directly operated on? Just wanted clarification on this. Thanks Dr.

Answer
Tyler:

The deep or internal spermatic fascia is deep to the cremaster muscle, directly surrounds the spermatic cord and its contents, and is a continuation of the abdominal transversalis fascia.

I can't tell whether or not the surgery was potentially close enough to the expected location of the nerve from the available description except that since the surgery was done outside the external ring it would seem unlikely for this nerve to be harmed.  I should point out that your symptoms suggests a nerve injury at the time of the surgery that could be due to the nerve being in an unusual or abnormal position.  Either way, there isn't much that can be done about it now except to wait and hope that it recovers over time. I suggest you discuss this further with your surgeon or consider a formal second opinion.  

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Stephen W. Leslie, MD

Expertise

Questions concerning erectile dysfunction, kidney stones and prostate disorders including prostate cancer. I have a special interest in kidney stone disease prevention.

Experience

Full time practicing urologist with 30 years experience. Associate Professor of Surgery and Chief of Urology at Creighton University Medical Center. Editor in Chief of eMedicine Urology internet textbook. Author of only NIH approved book written for patients by a urologist on the subject of kidney stones "The Kidney Stones Handbook". Inventor of the "Parachute" and "Escape" kidney stone baskets and the "Calculus" stone prevention analysis computer program.

Organizations
American Urological Association, Ohio State Medical Association, Sexual Medicine Society

Publications
Men's Health, Journal of Urology, Urology, Healthwatch Magazine, Emergency Medicine Monthly, eMedicine, "The Kidney Stones Handbook", and numerous articles in various newspapers. He is also the editor of the Urology Board Review by McGraw-Hill used by urologists to study for their Board Certification Examinations.

Education/Credentials
Graduate of New York Medical College with residencies completed at Metropolitan Hospital New York, Albany Medical Center and University of Wisconsin-Madison.

Awards and Honors
Thirlby Award of the American Urological Association. Rated as one the country's Best Urologists by the Independent Consumer's Research Institute

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