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

Abstract

Chronic orchalgia is a frustrating clinical problem for both the patient and the physician. We present a 17-year-old boy with a bilateral idiopathic chronic intractable orchalgia with failed conservative treatment. For 2 years, he suffered from severe attacks of scrotal pain that affected his daily activities and caused frequent absence from school. Ultrasound-guided pulsed radiofrequency ablation (PRF) of the genital branches of the genitofemoral nerve performed after local anesthetic nerve block confirmed the diagnosis and yielded 6 weeks of symptom relief. Seven-month follow-up revealed complete satisfactory analgesia. The use of PRF is an effective and non-invasive approach to treat intractable chronic orchalgia.

Evaluation and Management of Chronic Scrotal Content Pain

“…Pulsed radiofrequency of the spermatic cord and genital branch of the genitofemoral nerve have recently been reported for treatment of chronic testicular pain in small noncontrolled trials [44,45]. This approach seems particularly effective when a cord block results in local temporary relief.…”

“…Predictors of successful epididymectomy include a palpable painful epididymis and tender cystic lesions isolated to the epididymis. Predictors of poor outcome include presence of chronic inflammation of the epididymis without structural findings on examination or ultrasound imaging and pain in adjacent structures including the testicle or cord [45].…”

Successful management of a refractory case of postoperative herniorrhaphy pain with extended duration pulsed radiofrequency

“…The testicular and vas deferens vessels were located with color Doppler. [ 3 ] Using an in-plane technique, a 5 cm, 22 G RF cannula was advanced toward the genital branch of the genitofemoral nerve (GGFN) using the in-plane technique. Correct needle positioning was verified with sensory stimulation and motor stimulation.…”

“…A diagnostic block in GGFN with 5 ml of 0.2% ropivacaine and 20 mg of triamcinolone resulted in preblock VAS of 100 to zero in the right testicular area. However, after 2 weeks, the VAS increased to 50 on movement and after 1-month PRF of GGFN[ 3 ] was performed (8 min) using the same methodology described above. The procedure reduced VAS from preblock VAS of 50 on movement to postblock VAS of zero.…”

Sonographie peripherer Nerven

“…Der Ultraschall eignet sich teilweise auch zur Behandlung von Kompressionssyndromen (ultraschallgestützte Blockaden mit Lokalanästhetika und Kortison) und weist dabei eine höhere Blockerfolgsrate mit weniger Nebenwirkungen (z.B. Blutungen) auf[1,12,13,19,38,56,58,63].Abbildung 3. Verschiedene Pathologien.…”