Chronic orchialgia: Review of treatments old and new

Bayo Tojuola, Jeffrey Layman, Ibrahim Kartal, Ahmet Gudelogul, Jamin Brahmbhatt, Sijo Parekattil, Bayo Tojuola, Jeffrey Layman, Ibrahim Kartal, Ahmet Gudelogul, Jamin Brahmbhatt, Sijo Parekattil

Abstract

Introduction: Chronic orchialgia is historically and currently a challenging disease to treat. It is a diagnostic and therapeutic challenge for physicians. Conservative therapy has served as the first line of treatment. For those who fail conservative therapy, surgical intervention may be required. We aim to provide a review of currently available surgical options and novel surgical treatment options.

Methods: A review of current literature was performed using PubMed. Literature discussing treatment options for chronic orchialgia were identified. The following search terms were used to identify literature that was relevant to this review: Chronic orchialgia, testicular pain, scrotal content pain, and microsurgical denervation of the spermatic cord (MDSC).

Results: The incidence of chronic orchialgia has been increasing over time. In the USA, it affects up to 100,000 men per year due to varying etiologies. The etiology of chronic orchialgia can be a confounding problem. Conservative therapy should be viewed as the first line therapy. Studies have reported poor success rates. Current surgical options for those who fail conservative options include varicocelectomy, MDSC, epididymectomy, and orchiectomy. Novel treatment options include microcryoablation of the peri-spermatic cord, botox injection, and amniofix injection.

Conclusion: Chronic orchialgia has been and will continue to be a challenging disease to treat due to its multiple etiologies and variable treatment outcomes. Further studies are needed to better understand the problem. Treatment options for patients with chronic orchialgia are improving. Additional studies are warranted to better understand the long-term durability of this treatment options.

Keywords: Chronic orchialgia; chronic scrotal pain; testicular pain.

Figures

Figure 1
Figure 1
Old chronic orchialgia treatment algorithm
Figure 2
Figure 2
Under percutaneous ultrasound guidance determine left spermatic cord from lateral side at the level of external inguinal ring
Figure 3
Figure 3
Injection sites for botox and amniofix injections
Figure 4
Figure 4
Proposed new treatment algorithm for chronic orchialgia

References

    1. Strebel RT, Leippold T, Luginbuehl T, Muentener M, Praz V, Hauri D. Chronic scrotal pain syndrome: Management among urologists in Switzerland. Eur Urol. 2005;47:812–6.
    1. Parekattil SJ, Gudeloglu A, Brahmbhatt JV, Priola KB, Vieweg J, Allan RW. Trifecta nerve complex: Potential anatomical basis for microsurgical denervation of the spermatic cord for chronic orchialgia. J Urol. 2013;190:265–70.
    1. Costabile RA, Hahn M, McLeod DG. Chronic orchialgia in the pain prone patient: The clinical perspective. J Urol. 1991;146:1571–4.
    1. Bruning CO., 3rd Re: Vasectomy reversal for treatment of the post-vasectomy pain syndrome. J Urol. 1997;158:1528.
    1. Chen TF, Ball RY. Epididymectomy for post-vasectomy pain: Histological review. Br J Urol. 1991:407–13.
    1. Choe JM, Kirkemo AK. Questionnaire-based outcomes study of nononcological post-vasectomy complications. J Urol. 1996;155:1284–6.
    1. Devine CJ, Jr, Schellhammer PF. The use of microsurgical denervation of the spermatic cord for orchialgia. Trans Am Assoc Genitourin Surg. 1978;70:149–51.
    1. Dickinson KJ, Thomas M, Fawole AS, Lyndon PJ, White CM. Predicting chronic post-operative pain following laparoscopic inguinal hernia repair. Hernia. 2008;12:597–601.
    1. Edwards IS. Vasectomy reversal for treatment of the post-vasectomy pain syndrome. J Urol. 1997;158:2252.
    1. Loos MJ, Roumen RM, Scheltinga MR. Classifying post-herniorrhaphy pain syndromes following elective inguinal hernia repair. World J Surg. 2007;31:1760–5.
    1. Massaron S, Bona S, Fumagalli U, Battafarano F, Elmore U, Rosati R. Analysis of post-surgical pain after inguinal hernia repair: A prospective study of 1,440 operations. Hernia. 2007;11:517–25.
    1. McLoughlin J, Kelley CJ. Study of the effectiveness of bupivicaine infiltration of the ilioinguinal nerve at the time of hernia repair for post-operative pain relief. Br J Clin Pract. 1989;43:281–3.
    1. McMahon AJ, Buckley J, Taylor A, Lloyd SN, Deane RF, Kirk D. Chronic testicular pain following vasectomy. Br J Urol. 1992;69:188–91.
    1. Morris C, Mishra K, Kirkman RJ. A study to assess the prevalence of chronic testicular pain in post-vasectomy men compared to non-vasectomised men. J Fam Plann Reprod Health Care. 2002;28:142–4.
    1. Myers SA, Mershon CE, Fuchs EF. Vasectomy reversal for treatment of the post-vasectomy pain syndrome. J Urol. 1997;157:518–20.
    1. Nangia AK, Myles JL, Thomas AL., JR Vasectomy reversal for the post-vasectomy pain syndrome: A clinical and histological evaluation. J Urol. 2000;164:1939–42.
    1. Levine LA, Matkov TG, Lubenow TR. Microsurgical denervation of the spermatic cord: A surgical alternative in the treatment of chronic orchialgia. J Urol. 1996;155:1005–7.
    1. Levine LA, Matkov TG. Microsurgical denervation of the spermatic cord as primary surgical treatment of chronic orchialgia. J Urol. 2001;165(6 Pt 1):1927–9.
    1. Levine LA. Microsurgical denervation of the spermatic cord. J Sex Med. 2008;5:526–9.
    1. Oliveira RG, Camara C, Alves Jde M, Coelho RF, Lucon AM, Srougi M. Microsurgical testicular denervation for the treatment of chronic testicular pain initial results. Clinics (Sao Paulo) 2009;64:393–6.
    1. Strom KH, Levine LA. Microsurgical denervation of the spermatic cord for chronic orchialgia: Long-term results from a single center. J Urol. 2008;180:949–53.
    1. Taguchi K, Tsukamoto T, Murakami G. Anatomical studies of the autonomic nervous system in the human pelvis by the whole-mount staining method: Left-right communicating nerves between bilateral pelvic plexuses. J Urol. 1999;161:320–5.
    1. Dubový P. Wallerian degeneration and peripheral nerve conditions for both axonal regeneration and neuropathic pain induction. Ann Anat. 2011;193:267–75.
    1. Gaudet AD, Popovich PG, Ramer MS. Wallerian degeneration: Gaining perspective on inflammatory events after peripheral nerve injury. J Neuroinflammation. 2011;8:110.
    1. Granitsiotis P, Kirk D. Chronic testicular pain: An overview. Eur Urol. 2003;45:430–6.
    1. Heidenreich A, Olbert P, Engelmann UH. Management of chronic testalgia by microsurgical testicular denervation. Eur Urol. 2002;41:392–7.
    1. Davis BE, Noble MJ, Weigel JW, Foret JD, Mebust WK. Analysis and management of chronic testicular pain. J Urol. 1990;143:936–9.
    1. Nickel JC, Siemens DR, Nickel KR, Downey J. The patient with chronic epididymitis: Characterization of an enigmatic syndrome. J Urol. 2002;167:1701–4.
    1. Tracy CR, Steers WD, Costabile R. Diagnosis and management of epididymitis. Urol Clin North Am. 2008;35:101–8; vii.
    1. Chen SS. Factors predicting symptomatic relief by varicocelectomy in patients with normospermia and painful varicocele nonresponsive to conservative treatment. Urology. 2012;80:585–9.
    1. Yaman O, Ozdiler E, Anafarta K, Gögüs O. Effect of microsurgical subinguinal varicocele ligation to treat pain. Urology. 2000;55:107–8.
    1. Abrol N, Panda A, Kekre NS. Painful varicoceles: Role of varicocelectomy. Indian J Urol. 2014;30:369–73.
    1. Maghraby HA. Laparoscopic varicocelectomy for painful varicoceles: Merits and outcomes. J Endourol. 2002;16:107–10.
    1. Kim HT, Song PH, Moon KH. Microsurgical ligation for painful varicocele: Effectiveness and predictors of pain resolution. Yonsei Med J. 2012;53:145–50.
    1. Park HJ, Lee SS, Park NC. Predictors of pain resolution after varicocelectomy for painful varicocele. Asian J Androl. 2011;13:754–8.
    1. Parekattil SJ, Gudeloglu A. Robotic assisted andrological surgery. Asian J Androl. 2013;15:67–74.
    1. Padmore DE, Norman RW, Millard OH. Analyses of indications for and outcomes of epididymectomy. J Urol. 1996;156:95–6.
    1. West AF, Leung HY, Powell PH. Epididymectomy is an effective treatment for scrotal pain after vasectomy. BJU Int. 2000;85:1097–9.
    1. Parvis KK, Costabile RA. Orchialgia and the chronic pelvic pain syndrome. World J Urol. 2013;31:773–8.
    1. Beazley RM, Bagley DH, Ketcham AS. The effect of cryosurgery on peripheral nerves. J Surg Res. 1974;16:231–4.
    1. Breidenach LM, Thomford N, Pace WG. Cryosurgery of tumors involving the facial nerve. Arch Surg. 1972;105:306–7.
    1. Carter DC, Lee PW, Gill W, Johnston RJ. The effect of cryosurgery on peripheral nerve function. J R Coll Surg Edinb. 1972;17:25–31.
    1. Mandeville AF, McCabe BF. Some observations on the cryobiology of blood vessels. Laryngoscope. 1967;77:1328–50.
    1. Whittaker DK. Degeneration and regeneration of nerves following cryosurgery. Br J Exp Pathol. 1974;55:595–600.
    1. Morré HH, Keizer SB, van Os JJ. Treatment of chronic tennis elbow with botulinum toxin. Lancet. 1997;349:1746.

Source: PubMed

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