Chronic orchialgia: Review of treatments old and new

Abstract

Introduction:Chronic orchialgia is historically and currently a challenging disease to treat. It is a diagnostic and therapeutic challenge for physicians. Conservative therapy has served as the first line of treatment. For those who fail conservative therapy, surgical intervention may be required. We aim to provide a review of currently available surgical options and novel surgical treatment options.Methods:A review of current literature was performed using PubMed. Literature discussing treatment options for chronic orchialgia were identified. The following search terms were used to identify literature that was relevant to this review: Chronic orchialgia, testicular pain, scrotal content pain, and microsurgical denervation of the spermatic cord (MDSC).Results:The incidence of chronic orchialgia has been increasing over time. In the USA, it affects up to 100,000 men per year due to varying etiologies. The etiology of chronic orchialgia can be a confounding problem. Conservative therapy should be viewed as the first line therapy. Studies have reported poor success rates. Current surgical options for those who fail conservative options include varicocelectomy, MDSC, epididymectomy, and orchiectomy. Novel treatment options include microcryoablation of the peri-spermatic cord, botox injection, and amniofix injection.Conclusion:Chronic orchialgia has been and will continue to be a challenging disease to treat due to its multiple etiologies and variable treatment outcomes. Further studies are needed to better understand the problem. Treatment options for patients with chronic orchialgia are improving. Additional studies are warranted to better understand the long-term durability of this treatment options.

Microsurgical Denervation of Spermatic Cord for Chronic Idiopathic Orchialgia: Long-Term Results from an Institutional Experience

“…This inflammatory change leads to neural hypersensitivity [58]. Various modalities which are available for the management of chronic orchalgia are listed in Table 3 [910].…”

Extirpative surgery for chronic orchialgia: is there a role?

“…The incidence of chronic orchialgia is increasing over time possibly related to increased willingness of providers to address this pain (11). Psychological patient factors are associated with chronic orchialgia and may contribute to the rising incidence.…”

“…The exact etiology of chronic scrotal pain is often not identified and the pathophysiology not fully understood (1,2,4,11,14). Twenty-five percent to 50% of cases are noted to be idiopathic.…”

Genital pain: algorithm for management

“…Although a common complaint in Urology or Andrology, it is historically and currently a challenging disease to treat (2,3). With an increase in easily available information by the media, the last decade has seen an explosion in magazines focusing on men’s health and men’s problems.…”

“…Chronic testicular pain is a common long-term disability reported in North America and results in significant loss of work productivity and an increase in direct and indirect healthcare costs ( 1 ). Although a common complaint in Urology or Andrology, it is historically and currently a challenging disease to treat ( 2 , 3 ). With an increase in easily available information by the media, the last decade has seen an explosion in magazines focusing on men’s health and men’s problems.…”