A Review of the Management of Chronic Scrotal Pain.

Amr Moubasher,Oliver Brunckhorst,Kamran Ahmed,Nicholas Raison,Muhammad Waqar

doi:10.7759/cureus.11979

Amr Moubasher, Oliver Brunckhorst + Show 3 more

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https://doi.org/10.7759/cureus.11979

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Abstract

Chronic scrotal pain (CSP) is a common and poorly understood medical condition that significantly affects individuals’ quality of life. Many patients seek evaluation and management of their symptoms from multiple physicians. Our review aims to address diagnostic modalities, clinical evaluation, and surgical and non-surgical management.We conducted a computerised detailed search of the PubMed, Medline, Embase and Cochrane databases for reports pertaining to CSP using the Medical Subject Headings keywords ‘chronic scrotal pain’, ‘testicular pain’ and ‘orchialgia’, and we included in the review those that fulfilled the inclusion (adult male with CSP presenting with the criteria of CSP ) and exclusion (extra-scrotal pain) criteria.After the direct causes of CSP were identified by reviewing the clinical evaluations (history taking and examination are mandatory) and the diagnostic evaluations (urine analysis is crucial and ultrasound can be helpful), the most-used medical and non-surgical treatments for CSP were tricyclic antidepressants (success rate of up to 66.6%) and spermatic block (success rate of more than 90%), and the most-used surgical procedure was microsurgical denervation of the spermatic cord (success rate of up to 70%).The evidence currently available remains rare and of low quality, making it difficult to strongly recommend individual treatment options. However, multimodal treatment modalities using physical therapy and psychotherapy may help patients and provide useful tools for coping with this condition. There are also useful non-surgical and surgical options for CSP that depend on the patient’s state, the severity of the complaint and what options have already been tried.

Highlights

BackgroundScrotal pain, in both its acute and chronic forms, is a diagnostic challenge that must be carefully evaluated using a full patient history and physical examination
We conducted a computerised detailed search of the PubMed, Medline, Embase and Cochrane databases for reports pertaining to Chronic scrotal pain (CSP) using the Medical Subject Headings keywords ‘chronic scrotal pain’, ‘testicular pain’ and ‘orchialgia’, and we included in the review those that fulfilled the inclusion and exclusion criteria
After the direct causes of CSP were identified by reviewing the clinical evaluations and the diagnostic evaluations, the most-used medical and non-surgical treatments for CSP were tricyclic antidepressants and spermatic block, and the most-used surgical procedure was microsurgical denervation of the spermatic cord

Summary

Introduction

In both its acute and chronic forms, is a diagnostic challenge that must be carefully evaluated using a full patient history and physical examination. The recognisable and reversible causes of CSP include varicocele, epididymitis, spermatocele, tumour, infection and torsion. This condition has been referred to by many names, including chronic orchialgia, testicular pain syndrome, testalgia, chronic scrotal content pain, post-vasectomy orchialgia, post-vasectomy pain syndrome (PVPS), congestive epididymitis and chronic testicular pain. Several studies have provided estimates of the prevalence of the condition in patients, with frequencies ranging from 0.4% to 4.75% in specific groups of men [4]

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