Chronic Scrotal Pain Research Articles

073 Evaluation of Hip Pathology in Men Presenting with Chronic Scrotal Content Pain

073 Evaluation of Hip Pathology in Men Presenting with Chronic Scrotal Content Pain

Moxibustion May Be a Potentially Effective Treatment for Chronic Scrotal Content Pain? A Case Report

Background: Chronic scrotal content pain (CSCP) is a syndrome that seriously affects the quality of life in men. But in most men, there is no obvious structural abnormality and there may not be any identifiable pain on palpation, even medications and surgeries are not 100% effective and maybe cause other problems. In addition to medications and surgical treatment, any other effective method needs to be a therapeutic option, too. Objective: To discuss a 36-year-old patient with chronic scrotal content pain for 3 years, with a view to introduce a potentially effective treatment for Chronic scrotal content pain. Conclusions: Many pain syndromes can be treated with removal of the original stimulus. For the patients we treat, moxibustion is effective for the treatment of Chronic scrotal content pain caused by the cooling on the portion. Therefore, an effective conservative treatment may be a worthwhile option to try.

Chronic Scrotal Content Pain: a Review of the Literature and Management Schemes.

Chronic scrotal content pain (CSCP) is a complex condition with multiple etiologies that requires a thorough understanding of its pathophysiology, workup, and treatment options. We performed a comprehensive and contemporary review to augment our current understanding of CSCP. We discuss new advances in CSCP-specific pain questionnaires, modern studies of microscopic spermatic cord denervation and its variations, and novel techniques including electric nerve stimulation and cryoablation in addition to randomized control trials with significant negative findings. We also present literature focusing on the prevention of CSCP secondary to surgical iatrogenic causes. The constantly evolving literature of CSCP has led to the significant evolution in its diagnosis and treatment, from oral medications to salvage options after microscopic spermatic cord denervation. With each advance, we come closer to developing a more thorough, evidence-based algorithm to guide urologists in treatment of CSCP.

Diagnosis and management of a scrotal wall mass with the aid of a Scrotoscope: a descriptive observational study

Background and objective: A scrotal wall mass is relatively rare in clinical practice, and very difficult to differentiate from a scrotal content lesion by a physical or ultrasound examination. In this study, we share our experience with the scrotoscope for diagnosing and treating scrotal wall masses. Methods: We retrospectively reviewed all clinical data of scrotal wall mass patients treated by our medical team between June 2015 and July 2019. Diagnostic value was evaluated by comparison with a Doppler ultrasound examination and therapeutic value was evaluated by comparison with traditional surgery. Suspected scrotal tuberculosis or malignant scrotal tumor patients were excluded. Results: Six patients with scrotal wall masses were diagnosed and treated with the scrotoscope. A preoperative ultrasound examination led to an ambiguous or incorrect diagnosis for the origin of the scrotal wall masses in all six cases. The location of all of the masses was confirmed by exploring with the scrotoscope. Three patients were diagnosed with scrotal wall cysts, and one was successfully resected during the procedure; the other two were resected through a small incision. Four scrotal wall solid masses were resected in the other three patients through small incisions after the diagnosis using the scrotoscope. No wound infection, scrotal edema, hematoma, chronic scrotal pain, or injury to the testicles or epididymis were observed. Conclusions: Scrotal wall masses are relatively rare, and it was very difficult to obtain a firm diagnosis of their origin using preoperative ultrasound. The scrotoscope confirmed localization of the tumor, and provided us important information for a minimally invasive resection. Endoscopic resection of a mass can be performed using a scrotoscope.

Forty-Five Cases of Chronic Testicular Pain and Groin Pain Treated with Kampo Medicine

Forty-Five Cases of Chronic Testicular Pain and Groin Pain Treated with Kampo Medicine

A Review of the Management of Chronic Scrotal Pain.

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.

Microscopic spermatic cord denervation for chronic orchialgia/chronic scrotal content pain: operative outcomes and predictors of failure.

BackgroundTo describe our institutional outcomes with microscopic spermatic cord denervation (MSCD) for chronic scrotal content paint (CSCP) and identify predictors of treatment failure.MethodsRetrospective chart review was performed to identify all MSCD performed by two surgeons at a single institution from 2010–2019. Patient demographic data and operative outcomes were collected. Patients were excluded from analysis if no post-operative follow up was available. Success was defined as complete resolution of bothersome pain. Multivariable logistic regression was utilized to identify predictors of treatment failure.ResultsDuring the study period, 101 patients were identified in which 113 MSCD procedures were performed. Final analysis included 103 procedures across 93 patients. Mean age was 41.8 years (SD 13.2), mean BMI was 29.2 kg/m2 (SD 5.96) and median months of pain preceding surgery were 24 (range, 3–300 months). Overall, 75/103 (73%) MSCD were successful. Of the failures, 5 patients had recurrence of pain greater than 6 months after surgery. Only the presence of pelvic floor muscle spasm (PFMS) independently predicted MSCD failure (OR 3.95, P=0.02). 9 of 19 (47%) patients with PFMS experienced treatment failure, while 19 of 84 (23%) without PFMS experienced failure.ConclusionsMSCD offers a therapeutic option for patients with refractory CSCP. The presence of PFMS is associated with lower surgical success rates. Patients with pre-operatively identified PFMS should be counseled regarding a higher risk of treatment failure.

Targeted Microsurgical Denervation of the Spermatic Cord for Chronic Orchialgia: the Current Standard of Care.

This paper reviews the pathophysiology, current literature, techniques for full microsurgical denervation (MDSC) and targeted microsurgical denervation (TMDSC) of the spermatic cord, and outcomes for these treatment options for patients with chronic scrotal content pain (CSCP) or orchialgia. Significant reduction in pain (77-100%) is reported across various studies for CSCP patients with minimal patient morbidity. The testicular atrophy/loss risk is less than 1%. Testosterone levels do not appear to be affected by TMDSC/MDSC. The outcomes between TMDSC and MDSC are comparable (not statistically significantly different). However, TMDSC is significantly more efficient and a lot less tedious to perform. TMSCD had a shorter microsurgical operative time (21min vs 53min, P = 0.0001) than MDSC. Targeted or full microsurgical denervation of the spermatic cord is a safe and effective treatment option that is well published across several studies. The targeted MDSC approach is a more efficient and potentially less risky approach with similar outcomes to full MDSC.

Etiology of testicular pain 2019: Classification into ten logical subgroups

Background: Testicular pain encompasses a vast medical diagnostic field, with numerous organ and system convergence. Acute testicular pain is a medical emergency that requires accurate evaluation and immediate resolution, whereas chronic testicular pain is enigmatic and requires sound knowledge of the mechanisms of testicular pain and the differential diagnosis.
 Objective: To review the causes of testicular pain and propose a new etiologic classification consisting of 10 subgroups. 
 Methods: A bibliographic search was carried out utilizing Google and the National Library of Medicine’s PubMed databases to identify original articles and review articles (hard copy or electronic) published on testicular pain, up to March 2020. The search included: MeSH terms: testicular disease (classification, complications, etiology, trauma, microbiology, pathology, pathophysiology, secondary, surgery, treatment) and vasectomy; Non-MeSH terms: acute and chronic orchialgia, scrotalgia, orchidynia, groin pain, epididymalgia, testalgia, chronic testicular pain, chronic scrotal pain syndrome, testicular pain syndrome, epididymal pain syndrome, and post-vasectomy pain syndrome. The initial search produced 625 articles, of which 143 were included in the present review.
 Results: To better understand testicular pain etiology, 100 possible diagnoses were divided into ten subgroups: infectious, neoplastic, traumatic, torsional, vascular, immunologic, neurologic, pharmacologic, obstructive, and miscellaneous causes. Likewise, treatment can be divided into two main groups, according to therapeutic options: pharmacologic and non-pharmacologic, with the latter subdivided into: noninvasive and the increasingly performed invasive (surgical) alternatives.
 Conclusions: Testicular pain should be understood as a complex pain syndrome of enigmatic origin. Treatment success depends on the correct identification, from hundreds of possibilities, of the cause of pain. Logical grouping of those possibilities could aid in making the accurate etiologic identification.

Etiology of testicular pain 2019: Classification into ten logical subgroups

Background: Testicular pain encompasses a vast medical diagnostic field, with numerous organ and system convergence. Acute testicular pain is a medical emergency that requires accurate evaluation and immediate resolution, whereas chronic testicular pain is enigmatic and requires sound knowledge of the mechanisms of testicular pain and the differential diagnosis.
 Objective: To review the causes of testicular pain and propose a new etiologic classification consisting of 10 subgroups. 
 Methods: A bibliographic search was carried out utilizing Google and the National Library of Medicine’s PubMed databases to identify original articles and review articles (hard copy or electronic) published on testicular pain, up to March 2020. The search included: MeSH terms: testicular disease (classification, complications, etiology, trauma, microbiology, pathology, pathophysiology, secondary, surgery, treatment) and vasectomy; Non-MeSH terms: acute and chronic orchialgia, scrotalgia, orchidynia, groin pain, epididymalgia, testalgia, chronic testicular pain, chronic scrotal pain syndrome, testicular pain syndrome, epididymal pain syndrome, and post-vasectomy pain syndrome. The initial search produced 625 articles, of which 143 were included in the present review.
 Results: To better understand testicular pain etiology, 100 possible diagnoses were divided into ten subgroups: infectious, neoplastic, traumatic, torsional, vascular, immunologic, neurologic, pharmacologic, obstructive, and miscellaneous causes. Likewise, treatment can be divided into two main groups, according to therapeutic options: pharmacologic and non-pharmacologic, with the latter subdivided into: noninvasive and the increasingly performed invasive (surgical) alternatives.
 Conclusions: Testicular pain should be understood as a complex pain syndrome of enigmatic origin. Treatment success depends on the correct identification, from hundreds of possibilities, of the cause of pain. Logical grouping of those possibilities could aid in making the accurate etiologic identification.

Application of Botulinum Neurotoxin in Male Sexual Dysfunction: Where Are We Now?

Botulinum neurotoxin (BoNT) is a recognized therapeutic agent of modern medical care, routinely used to treat medical conditions affecting a variety of organ systems including the musculoskeletal, integumentary, and urological domains. Ongoing research is exploring BoNT's potential role as a therapeutic agent for a variety of male sexual pathologies. To review and analyze the literature regarding BoNT as a treatment option for male sexual dysfunction. A PubMed search was performed for English-language articles in peer-reviewed journals between 1970 and 2019 (with one article from 1897). Relevant articles referenced within these texts were also included. One article did not have an accompanied English full-text available. The following search terms were used: "Botox", "Botulinum toxin", "Botulinum toxin A", "Onabotulinum A", "Abobutlinum A", "BoNT", "BoNT-A", "Male sexual health", "Male sexual pathology", "Peyronie's disease", "Premature ejaculation", "Scrotal Pain", "Penile Retraction", "Scrotox", "Erectile Dysfunction", and "Botox in Urology". There is interest in the potential role of BoNT in the treatment of male sexual pathologies. We identified studies that used BoNT to treat chronic scrotal content pain, premature ejaculation, erectile dysfunction, Peyronie's disease, penile retraction, and more. However, despite preclinical/clinical data indicating some potential efficacy and safety in these settings, a lack of robust clinical trial data has resulted in no current Food and Drug Administration-approved indications for the use of BoNT in the treatment of male sexual pathology. As a result, much of the current use of BoNT by today's providers is "off-label," and ongoing clinical trials aim to further elucidate the potential role of this therapeutic agent. Current data suggest that BoNT could have a potential role as a treatment option for certain types of male sexual pathologies. However, more randomized controlled trial data regarding its long-term safety and efficacy are necessary before a widespread clinical adoption can take place. Reddy AG, Dick BP, Natale C, etal. Application of Botulinum Neurotoxin in Male Sexual Dysfunction: Where Are We Now?. J Sex Med 2021;9:320-330.

Taming of the Testicular Pain Complicating Lumbar Disc Herniation With Spinal Manipulation.

Degenerative disease of the lumbar spine is often ignored as a potential cause of testicular pain because the exact link between the two remains uncertain. This article reports the case of a 60-year-old man with a 3-year history of low back pain and unexplained right testicular pain for 2 years. Painful symptoms were negatively affecting his social, physical, and sexual functions. After failure to achieve pain relief through multiple types of therapy, the patient sought chiropractic treatment for his condition. Lumbar spine magnetic resonance imaging (MRI) revealed disc protrusion at the L1/L2, L3/L4, and L4/L5 segments causing thecal sac indentations. Due to the absence of direct testicular causes, the medical impression was chronic testicular pain (CTP) complicating lumbar disc disease. The patient experienced regular improvement in his low back and testicular pain with complete resolution of both after 8 weeks of chiropractic treatment. This article describes an overlook of the etiology of this patient’s testicular pain and a successful option in treating the patient. CTP has multifactorial etiology. An excellent treatment outcome depends heavily on recognizing the origin of the pain.

291 - Double blinded, a randomized, double-blinded, control trial shows that onabotulinum toxin A (Botox®) nerve blocks do not provide improved long term pain control compared to control treatments for men with chronic scrotal pain

291 - Double blinded, a randomized, double-blinded, control trial shows that onabotulinum toxin A (Botox®) nerve blocks do not provide improved long term pain control compared to control treatments for men with chronic scrotal pain

Management of Chronic Orchialgia: Challenges and Solutions - The Current Standard of Care.

IntroductionChronic scrotal content pain (CSP) or chronic orchialgia can be debilitating for patients and difficult to treat. There is a paucity of structured treatment algorithms to approach this difficult condition.MethodsA review of the literature was performed. Conservative treatment options are presented and then targeted surgical interventions that the urologist may perform are then presented in a structured algorithm format. Many of these patients may obtain a significant reduction in pain with some of these treatments.ResultsThis review presents the pathophysiology, a new assessment tool, and various treatment options available for CSP patients, such as targeted spermatic cord blocks, targeted and standard microsurgical denervation of the spermatic cord (77–100% success rates), ultrasound-guided peri-spermatic cord and ilioinguinal cryoablation (59–75% success rates), scrotox (botox) (56–72% success rates), targeted ilioinguinal and iliohypogastric peripheral nerve stimulation (72% success rate), radical orchiectomy (20–75% success rate), targeted robotic-assisted intra-abdominal denervation (71% success rate) and vasectomy reversal (69–100% success rates).ConclusionA structured and evidence-based approach to help urologists manage patients with chronic orchialgia or scrotal content pain is presented.

Efficacy and safety of pulsed radiofrequency as a method of dorsal root ganglia stimulation for treatment of non-neuropathic pain: a systematic review

BackgroundWe systematically reviewed the evidence on the efficacy and safety of dorsal root ganglion (DRG) targeted pulsed radiofrequency (PRF) versus any comparator for treatment of non-neuropathic pain.MethodsWe searched MEDLINE, CINAHL, Embase, PsycINFO, clinicaltrials.gov and WHO clinical trial register until January 8, 2019. All study designs were eligible. Two authors independently conducted literature screening. Primary outcomes were pain intensity and serious adverse events (SAEs). Secondary outcomes were any other pain-related outcome and any other safety outcome that was reported. We assessed the risk of bias using the Cochrane tool and Risk of Bias In Non-randomized Studies of Interventions (ROBINS-I). We conducted narrative evidence synthesis and assessed the conclusiveness of included studies regarding efficacy and safety.ResultsWe included 17 studies with 599 participants, which analyzed various pain syndromes. Two studies were randomized controlled trials; both included participants with low back pain (LBP). Non-randomized studies included patients with the following indications: LBP, postsurgical pain, pain associated with herpes zoster, cervicogenic headache, complex regional pain syndrome type 1, intractable vertebral metastatic pain, chronic scrotal and inguinal pain, occipital radiating pain in rheumatoid arthritis and chronic migraine. In these studies, the PRF was usually initiated after other treatments have failed. Eleven studies had positive conclusive statements (11/17) about efficacy; the remaining had positive inconclusive statements. Only three studies provided conclusiveness of evidence statements regarding safety – two indicated that the evidence was positive conclusive, and one positive inconclusive. The risk of bias was predominantly unclear in randomized and serious in non-randomized studies.ConclusionPoor quality and few participants characterize evidence about benefits and harms of DRG PRF in patients with non-neuropathic pain. Results from available studies should only be considered preliminary. Not all studies have reported data regarding the safety of the intervention, but those that did, indicate that the intervention is relatively safe. As the procedure is non-destructive and early results are promising, further comparative studies about PRF in non-neuropathic pain syndromes would be welcomed.

MP58-11 A MODIFIED PREOPERATIVE SPERMATIC CORD BLOCK PREDICTS SUCCESS FOLLOWING MICROSCOPIC SPERMATIC CORD DENERVATION SURGERY FOR CHRONIC SCROTAL PAIN

INTRODUCTION AND OBJECTIVE: Chronic scrotal pain is notoriously difficult to treat. After conservative methods have failed, a microscopic spermatic cord denervation (MSCD) procedure has been shown to be effective, but choosing the appropriate candidate is essential. A spermatic cord block has been reported as a predictor for postoperative success. The traditional block includes an injection inferior/medial to the pubic tubercle but may miss contributors to scrotal pain. Here we utilize a modified cord block that targets the 3 primary locations of Wallerian degeneration: cremasteric muscles, vasal sheath and posterior cord fat, and examine its efficacy in predicting postoperative pain. METHODS: All patients presenting with chronic scrotal pain who failed previous treatments were offered the modified block. This was performed by injecting 10mL 0.25% Marcaine circumferentially around the vas deferens and an additional 10mL anterior/medial to the external ring. Pain was assessed using the Numeric Rating Scale (NRS). Patients with 2019 were included in the study. Preoperative, post-block, and 1-month post-surgical pain was assessed. Laterality, age, prior groin surgery, and post-block pain free period were also record. A multivariate linear regression model was used to determine predictors of surgical success. RESULTS: Thirty consecutive patients were tested with the modified block and subsequently underwent MSCD. Mean age was 47 (20-74). Seven patients (23%) had previously undergone vasectomy and 9 (30%) had undergone hernioplasty. Mean post-block pain free period was 5.6hrs (1.5-24). Mean preoperative NRS was 7 (5-9). Following the block, mean pain reduction was 84%, while pain reduction following surgery was 78% (3 <50%; 6 50-69%; 21 clip_image002.png">70%). On multivariate linear regression analysis, reduction in pain following block was an independent predictor of postoperative success (p<0.001). No other factors, including post-block pain free period were statistically significant. CONCLUSIONS: This modified block technique can be utilized as an effective predictor of success following MSCD. Neither prior groin surgery or post-block pain free period were associated with postoperative pain level. A trial comparing this modified approach to traditional spermatic cord block as a method of selecting the optimal surgical candidate is warranted. Source of Funding: none

MP58-10 SPERMATIC CORD BLOCK SERIES AS A TREATMENT FOR CHRONIC SCROTAL CONTENT PAIN

INTRODUCTION AND OBJECTIVE:Chronic Scrotal Content Pain (CSCP) is a common urologic condition with a wide variety of etiologies. Patients who have relief of pain following a spermatic cord block wi...

MP58-09 SERIAL SPERMATIC CORD INJECTIONS WITH TRIAMCINOLONE FOR CHRONIC TESTICULAR PAIN

INTRODUCTION AND OBJECTIVE:Chronic testicular pain remains a challenging problem for both patients and urologists, for which microsurgical denervation of spermatic cord (MDSC) has proven to be a su...

Surgical Experience of No-scalpel Vasectomy: An Underutilized Procedure

Introduction: No-Scalpel Vasectomy is a safe and effective technique of male fertility control. It is a minor procedure with minimal side effects and thus increases the patient acceptance, who have a vital role in decision making for family planning. Aims: to present our experience and results in patients undergoing no-scalpel vasectomy, their motivating factors, the failure rate of vasectomy, complications and its effect on sexual desire and performance. Material and Method : A total of 204 patients undergoing a no-scalpel vasectomy between march 2015 and august 2019 were included. Details about their motivational factors, socio-demographic profile were noted and post vasectomy complications were recorded and assesed. Results: No immediate or delayed complications of haematoma, wound infection, scrotal sinus, vasectomy failure, sperm granuloma and chronic scrotal pain was observed. Only one patient presented with pain and stitch granuloma which was excised later. None of our patients presented with any psychological and sexual problems in the follow-up. Conclusions: Men are often reluctant to consider vasectomy because of inaccurate information and myths. No-Scalpel Vasectomy is a safe procedure, but adequate motivation and education about the procedure is a must with follow up and sperm count at 3 months.

Chronic Testicular Pain- A Review of Literature

Objective: To review the current understanding of testicular pain, possible etiology and the available treatment options. Materials and Methods: A literature search was made for abstract, original and review articles in the Medline, hand-searched relevant reference lists and conference proceedings and medical text book using the word “testicular pain” and orchialgia to find out possible etiology, understanding of testicular pain and treatment options. Results: After literature search, it has found that management of testicular pain sometimes a challenging work for an Urologist. Management differs for the original etiology and for testicular and extra testicular causes. Sometimes symptomatic treatment improve the quality of life but in few cases surgery is mandatory for relieve of pain. Conclusions: Management of chronic testicular pain depends on careful assessment of the causes. Relieve of symptoms is not always possible with analgesic only, in that case blockade of the spermatic cord will be helpful. Decision for surgery should not be undertaken quickly for there is no guarantee that there will always be resolution of pain For that reason patient should be counseled accordingly. Bangladesh Journal of Urology, Vol. 15, No. 1, Jan 2012 p.18-20