Abstract
ABSTRACT Objective : To review the outcomes of various therapeutic modalities that can be offered to patients with chronic orchialgia (CO) after failed conservative treatment. Methods : A literature search was conducted using the PubMed and MEDLINE databases searching for articles exploring different CO treatment modalities. A Preferred Reporting Items for Systematic Reviews and Meta-Analyses approach was used to report the results of the literature search. Results : A total of 34 studies were included for qualitative analysis. Most of the studies explored microsurgical spermatic cord denervation (MSCD; n = 19). Eight studies involved devices and interventions directed at blocking nerve sensations (pulsed radiofrequency stimulation, n = 5; transcutaneous electrical nerve stimulation, n = 1; cryoablation, n = 1; and mechanical vibratory stimulation, n = 1). Five studies reported on vasectomy reversal as a modality to relieve post-vasectomy pain syndrome (PVPS), while two studies explored the outcomes of orchidectomy on pain relief in patients with CO. Conclusion : Several treatment methods are available in the urologist’s armamentarium for the treatment of CO. MSCD appears to be an appealing treatment modality with encouraging outcomes. Neuropathic pain can be managed with a number of relatively non-invasive modalities. Vasectomy reversal is a sound treatment approach for patients with PVPS and ultimately orchidectomy is a terminal approach that can be discussed with patients suffering from intractable pain.
Highlights
Chronic orchialgia (CO) has been an escalating com plaint in the past few years, commonly affecting young men and interfering with their daily and sexual activ ities
The challenges faced in managing patients with CO stem from the fact that various aetiol ogies may result in overlapping symptoms, and while several treatment modalities exist, they may have sub optimal outcomes
Most studies reported the results of microsurgical sper matic cord denervation (MSCD) (n = 19) [9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27], while the remaining studies investigated the impact of var ious nerve-blocking techniques (n = 8) [28,29,30,31,32,33,34,35], vasect omy reversal (n = 5) [36,37,38,39,40], and extirpative surgery (n = 2) [41,42]
Summary
Chronic orchialgia (CO) has been an escalating com plaint in the past few years, commonly affecting young men and interfering with their daily and sexual activ ities. It is defined as continuous or intermittent, uni- or bilateral testicular discomfort of at least 3 months’ duration [1]. In the United States, up to 100,000 men are diagnosed with CO each year [2] While several causes, such as testicular infection or trauma, prior vasectomy, ingu inal hernia surgery, recurrent epididymitis, varicoceles, hydroceles and prior scrotal/abdominal surgery have been associated with CO, in many of the cases (50%) the exact aetiology remains unknown [3,4,5]
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