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Chronic Testicular and Groin Pain: Pathway to Relief

  • Men's Health (A Dabaja, Section Editor)
  • Published:
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Abstract

The management of patients suffering with chronic testicular and groin pain is very challenging. With increased awareness of men’s health, more patients and clinicians are open to talk about this complex problem that affects over 100,000 men/year. The pathogenesis of chronic orchialgia is still not clear, but there are several postulated theories. Treatment options include conservative medical therapy with NSAIDs, antidepressants, anticonvulsants, and narcotics. Surgical options such as targeted microsurgical denervation and microcryoablation can provide permanent durable pain relief. The goal of this article is to review and discuss the management of patients with chronic orchialgia using currently available literature.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Quallich SA, Arlsanian-Engoren C. Chronic testicular pain in adult men: an integrative literature review. Am J Mens Health. 2013;7(5):402–13.

    Article  PubMed  Google Scholar 

  2. Parekattil SJ, Cohen MS. Robotic surgery in male infertility and chronic orchialgia. Curr Opin Urol. 2010;20(1):75–9.

    Article  PubMed  Google Scholar 

  3. Levine LA. Microsurgical denervation of the spermatic cord. J Sex Med. 2008;5(3):526–9.

    Article  PubMed  Google Scholar 

  4. McMahon AJ, Buckley J, Taylor A, Lloyd SN, Deane RF, Kirk D. Chronic testicular pain following vasectiomy. Br J Urol. 1992;69(2):188–91.

    Article  CAS  PubMed  Google Scholar 

  5. Alfieri S, Amid PK, Campanelli G, et al. International guidelines for prevention and management of post-operative chronic pain following inguinal hernia surgery. Hernia. 2011;15(3):239–49.

    Article  CAS  PubMed  Google Scholar 

  6. Hakeem A, Shanmugam V. Current trends in the diagnosis and management of post-herniorraphy chronic groin pain. World J Gastrointest Surg. 2011;3(6):73–81.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Poobalan AS, Bruce J, Kind PM, Chambers WA, Krukowski ZH, Smith WC. Chronic pain and quality of life following open inguinal hernia repair. Br J Surg. 2011;88(8):1122–6.

    Article  Google Scholar 

  8. 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(6):812–6.

    Article  PubMed  Google Scholar 

  9. Belanger GV, VerLee GT. Diagnosis and surgical management of male pelvic, inguinal, and testicular pain. Surg Clin North Am. 2016;96(3):593–613.

    Article  PubMed  Google Scholar 

  10. Levine L. Chronic orchialgia: evaluation and discussion of treatment options. Ther Adv Urol. 2010;2(5–06):209–14.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Levine LA, Hoeh MP. Evaluation and management of chronic scrotal content pain. Curr Urol Rep. 2015;16:36.

    Article  PubMed  Google Scholar 

  12. Masarani M, Cox R. The aetiology, pathophysiology and management of chronic orchialgia. BJU Int. 2003;91(5):435–7.

    Article  CAS  PubMed  Google Scholar 

  13. • Cassidy DJ. Early experience with microsurgical spermatic cord denervation for chronic orchialgia at a Canadian centre. Can Urol Assoc J. 2015;9(1–2):e72–4. This reference reminds us that even as the incidence of CGSCP is increasing its pathophysiology is still not well understood. There are several theories out there with one of the leading theory being hyperstimulation of the nervous system.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Michael P. When to operate for scrotal pain? J Urol. 2013;190:13–4.

    Article  Google Scholar 

  15. Kumar P, Mehta V, Nargund VH. Clinical management of chronic testicular pain. Urol Int. 2010;84:125–31.

    Article  PubMed  Google Scholar 

  16. Raunchenwald M, Steers WD, Desjardins C. Efferent innervation of the rat testis. Biology of reproduction. 1995; 52(5):1136–43.

  17. •• Parekattil SJ, Gudeloglu A, Brahmbhatt JV, Priola KB, Viewed 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. This reference is very important as it brought light in the management of chronic orchialgia in the setting of nerve targeting. Because of this study, new techniques have evolved with targeting these particular nerves during the denervation procedure which lead to less inflammation, faster recovery, etc.

    Article  PubMed  Google Scholar 

  18. Van Haarst EP, Van Andel G, Rijcken TH, Schlatmann TJ, Taconis WK. Value of diagnostic ultrasound in patients with chronic scrotal pain and normal findings on clinical examination. Urology. 1999;54(6):1068–72.

    Article  PubMed  Google Scholar 

  19. Davies BE, Noble MJ, Weigel JW, Foret JD, Mebust WK. Analysis and management of chronic testicular pain. J Urol. 1990;143(5):936–9.

  20. Schover LR. Psychological factors in men with genital pain. Cleve J Med. 1990;57(8):697–700.

    Article  CAS  Google Scholar 

  21. Davies A, Hendrich J, Van Minh A, Wratten J, Douglas L, Dolphin AC. Functional biology of the alpha(2) delta subunits of voltage-gated calcium channels. Trends Pharmacol Sci. 2007;28(5):220–8.

    Article  CAS  PubMed  Google Scholar 

  22. Benson JS, Abern MR, Larsen S, Levine LA. Does a positive response to spermatic cord block predict response to microdenervation of the spermatic cord for chronic scrotal content pain? J Sex Med. 2013;20(3):876–82.

    Article  Google Scholar 

  23. Parekattil SJ, Gudeloglu A. Robotic assisted andrological surgery. Asian J Androl. 2013;15(1):67–74.

    Article  PubMed  Google Scholar 

  24. Laudano MA, Osterberg EC, Sheth S, et al. Microsurgery denervation of rat spermatic cord: safety and efficacy data. BJU Int. 2014;113(5):795–800.

    Article  PubMed  Google Scholar 

  25. Brahmbhatt JV, Parekattil SJ. Robotic-assisted microsurgery for male infertility and chronic orchialgia. New York: Robotics in General Surgery, Springer; 2014. p. 365–84.

    Google Scholar 

  26. • Oomen RJ, Witjens AC, Van Wijck AJ, Grobbee DE, Lock TM. Prospective double-blind preoperative pain clinic screening before microsurgical denervation of the spermatic cord in patients with testicular pain syndrome. Pain. 2014;155(9):1720–6. There is a lack of adequately published studies On CGSCP. Most if not all have been cohort studies. This is one of the first prospective studies on the matter which accordingly has an accurate conclusion: following a systematic protocol in the treatment of testicular pain syndrome is mandatory.

    Article  PubMed  Google Scholar 

  27. Saad E, Erik JC. Microsurgical varicocele repair on men with grade II lesions and chronic dull scrotal pain: a pilot study. Curr Urol. 2015;8(1):29–31.

    Article  Google Scholar 

  28. Dohle GR, Diemer T, Kopa Z, Krausz C, Giwercman A, Jungwirth A. European Association of Urology guidelines on vasectomy. Eur Urol. 2012;61(1):159–63.

    Article  PubMed  Google Scholar 

  29. Adams CE, Wald M. Risks and complications of vasectomy. Urol Clin N Am. 2009;36(3):331–6.

    Article  Google Scholar 

  30. 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.

    Article  PubMed  Google Scholar 

  31. Granitsiotis P, Kirk D. Chronic testicular pain: an overview. Eur Urol. 2004;45(4):430–6.

    Article  CAS  PubMed  Google Scholar 

  32. Gudeloglu A, Brahmbhatt JV, Parekattil SJ. Robotic microsurgery in male infertility and urology-taking robotics to the next level. Transl Androl Urol. 2014;3(1):102–12.

  33. Mirmovich O, Gil T, Goldin I, Lavi I, et al. Pain evaluation and control during and following the treatment of hypertrophic scars and kelois by contact and intralesional cryosurgery—a preliminary study. J Eur Acad Dermatol Venereol. 2012;26(4):440–7.

  34. Gudeloglu A, Brahmbhatt J, Har-Shai Y, Parekattil S. Micro-cryoablation of iolioinguinal and genitofemoral nerve fibers forpatients with persistent or recurrent chronic groin or scrotal content pain. San Diego: Engineering and Urology Society 28th Annual Meeting; 2013.

  35. Tojuola B, Layman J, Kartal I, Gudelogul A, Brahmbhatt J, Parekattil S. Chronic orchialgia: review of treatments old and new. Indian J Urol. 2016;32:21–6.

  36. Misra S, Ward S, Coker C. Pulsed radiofrequency for chronic testicular pain- a preliminary report. Pain Med. 2009;10(4):673–8.

    Article  PubMed  Google Scholar 

  37. Basal S, Ergin A, Yildirim I. A novel treatment of chronic orchialgia. J Androl. 2012;33(1):22–6.

    Article  PubMed  Google Scholar 

  38. Mcjunkin TL,Wuollet AL, Lynch PJ. Sacral nerve stimulation as a treatment modality for intractable neuropathic testicular pain. Pain Physician. 2009;12(6):991–5.

  39. Kiritsy MP, Siefferman JW. Spinal cord stimulation for intractable testicular pain: case report and review of the literature. Neuromodulation. 2016;19(8):889–92.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. South Lake Hospital / Orlando Health, 1900 Don Wickham Dr, Clermont, FL, 34711, USA

    Nahomy Calixte

  2. The PUR Clinic, South Lake Hospital, Clermont, FL, USA

    Nahomy Calixte, Jamin Brahmbhatt & Sijo Parekattil

Authors
  1. Nahomy Calixte
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  2. Jamin Brahmbhatt
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  3. Sijo Parekattil
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Contributions

Conception and design: Dr. Brahmbhatt.

Administrative Support: Dr. Parekattil and Dr. Brahmbhatt.

Provision of study material or patients: Dr. Parekattil and Dr. Brahmbhatt.

Collection and assembly of data: Dr. Calixte.

Data analysis and interpretation: Dr. Brahmbhatt and Dr. Calixte.

Manuscript writing: all authors.

Final approval of manuscript: all authors.

Corresponding author

Correspondence to Nahomy Calixte.

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Conflict of Interest

Nahomy Calixte, Jamin Brahmbhatt, and Sijo Parekattil each declare no potential conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Men’s Health

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Calixte, N., Brahmbhatt, J. & Parekattil, S. Chronic Testicular and Groin Pain: Pathway to Relief. Curr Urol Rep 18, 83 (2017). https://doi.org/10.1007/s11934-017-0722-7

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  • DOI: https://doi.org/10.1007/s11934-017-0722-7

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