Result of a standardized management protocol for chronic orchialgia and a suggested algorithm incorporating spermatic cord block, tender point block, microscopic vericocelectomy, and microscopic sub inguinal denervation.

Abstract

Purpose: We investigated Patients presenting with chronic orchialgia at Andrology in institute of kidney and diseases Peshawar, from 2003 August up to when were included.
 Materials and Methods: A thorough history and physical examination was undertaken including description of pain by the patient in terms of site, severity, radiation and associated pain. Extensive workup, directed by history and phsical examination, was done to rule out reversible causes of orchalgia. All patients had urinalysis, culture and ultrasound scrotum with color Doppler. Further investigations like semen analysis, culture and hormonal workup were done if indicated. The intensity of the pain was noted according to visual analogue scale. Patients were subdivided into three groups as mild pain (group A, pain score=1 - 3), moderate pain (group B, pain score=4 - 6) and severe pain, (group C, pain score=7 - 10). Site of pain and radiation/association to any other region was recorded.
 Finding: Results of the study indicated that 92 patients reported at institute of kidney diseases Peshawar with chronic orchialgia had their mean age at 37+/-4years. Five patients lost to followo 92 were included in final analysis (table 01). Pain was partially relieved in 14 patients and not relieved in another 9 patients which is almost 76% of total patients. These non-responders were compared with the remaining in which pain was completely relieved. There was no difference in etiology among responders and non-responders, however pain severity was more in non-responders at initial presentation (table 2).
 Conclusions: Patients with pelvic floor muscle spasm are more likely to experience treatment failure following microscopic subinguinal spermatic cord denervation for chronic scrotal content pain, even with a favorable response to spermatic cord block. A history relating to pelvic floor muscle spasm should be taken for all patients presenting with chronic orchialgia or chronic scrotal content pain, and digital rectal exam should be performed if the history is suggestive. If underlying pelvic floor dysfunction exists, pelvic floor physical therapy can be offered to patients prior to spermatic cord denervation. History of prior vasectomy, epididymectomy, prior inguinal or scrotal surgery or other patient demographic factors were not associated with treatment failure.