Idiopathic chronic orchialgia — a frustrating issue for the clinician and the patient

Abstract

Chronic testicular pain represents a management dilemma to clinicians and remains a very frustrating clinical problem. In nearly 25% of patients there is no obvious cause for idiopathic chronic orchialgia. Chronic testicular pain may occur at any age but the majority of patients are in 20-30 years of age group. The desired goal of the treatment is to allow the patient return to routine activity without signifi cant use of analgesics. There is very little published material, in urology, about the etiology and treatment of idiopathic chronic orchialgia but situation is not bleak since many treatment options do exist which can allow the patient enjoy life with mechanisms for coping with pain. A multidisciplinary team approach is required, so that the patient can benefi t from the different treatment options available at present.

Ultrasound-guided pulsed radiofrequency ablation of the genital branch of the genitofemoral nerve for treatment of intractable orchalgia

“…[5] The non-idiopathic forms are usually secondary to infection, tumor, varicoceles and spermatoceles, or as a complication of vasectomy or inguinal hernia repair. [6]…”

“…[569] Microsurgical denervation of the spermatic cord for treatment of chronic orchalgia is one of the minimally invasive approaches,[1011] with a reported success rate between 70% complete remission and 20% partial relief from pain. [11] However, it may cause possible distortion of anatomy and requires hospital admission.…”

Genital pain: algorithm for management

“…CO occurs at any age but the majority of the patients are in the 20–30 years of age group (7). It is the most cited urological reason for medical discharge in the US Army (8).…”

“…High levels of IL-6 and TNF-α have clearly been demonstrated in patients with complex regional pan syndromes providing evidence that depression and chronic pain share common biological pathways in the serotonergic and nor-adrenergic systems (4,7). …”

Symptomatic Male with Subclinical Varicocele Found on Ultrasound Evaluation

“…7 Internal spermatic veins are found to become palpable at diameters of 3.0-3.5 mm while reversal of flow is manually felt in veins >3.5 mm in diameter. 8 In addition to ultrasonography, other radiographic investigations such as spermatic venography, radionucleotide scanning, and thermography are available. The invasiveness and/or high cost of these investigations have rendered them less attractive and not commonly utilized in the diagnosis of varicocele.…”