Chronic Testicular Pain as a Symptom of Pelvic Floor Dysfunction

Planken, Erik; Zalm, Petra J. Voorham‐van der; Nijeholt, A.A.B. Lycklama à; Elzevier, Henk W.

doi:10.1016/j.juro.2009.08.147

Cited by 24 publications

(16 citation statements)

References 24 publications

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“…Scrotal pain could be due to either referred pain or idiopathic pain, and the testicular causes of pain include infection, tumor, testicular torsion, varicocele, hydrocele, spermatocele, trauma, or previous surgical intervention (12). Organs and body structures that share nerve pathways with scrotal structures, such as the ureter, the prostate or the hip, can cause referred pain in this area (12,13). Scrotal US is an important component of the evaluation of patients with scrotal pain (14).…”

Section: Discussionmentioning

confidence: 99%

Prevalence of scrotal calculi and its relationship to pain

Tan

Ozcan²,

Karaoğlanoğlu³

et al. 2011

Diagn Interv Radiol

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303T he presence of scrotal calculi is a relatively rare condition that is characterized by the presence of freely mobile calcified bodies between the layers of the tunica vaginalis of the testes, which are often found in patients who have been referred for scrotal ultrasound (1). The etiology of the scrotal calculi is uncertain. However, inflammatory changes within the remnants of the appendix, testis or epididymis may play a role in the development of these types of calculi (1, 2). There are a limited number of studies on scrotal calculi in the literature, and most of these are case reports. Furthermore, to our knowledge, no clinical trial has focused on whether there is a relationship between scrotal calculi and pain.The purpose of this large series study was to determine the frequency of scrotal calculi in men who were referred for scrotal ultrasound, and to identify any associated pathologic conditions in order to investigate whether any relationship exists between the presence of scrotal calculi and pain. Materials and methodsThis research was approved by the institutional human ethics committee at our hospital. A retrospective review of the radiology data processing system database revealed the existence of 4084 ultrasonography (US) scrotal reports from 3435 men between January 2008 and February 2011.US examinations were performed using US equipment with a 9-14 MHz linear probe (Logic9, GE Healthcare, Milwaukee, Wisconsin, USA) and with an 8-14 MHz linear probe (Technos MPX, Esaote, Genoa, Italy). US examinations were performed by two radiologists who were experienced in ultrasound techniques. The examinations were performed while the patient was lying in the supine position. The scrotum was immobilized prior to the application of a small amount of gel, and the US scans were performed in the transverse, longitudinal and multiple oblique planes. In this study, the patient information and the US findings were obtained from the US reports. These reports had been recorded in the radiology information system and we evaluated each of the scrotal US reports.Scrotal calculi were defined as typical round or oval echogenic foci with or without acoustic shadowing that were located between the layers of the tunica vaginalis of the testes (Fig. 1). Additionally, scrotal abnormalities, such as the presence of hydrocele or varicocele, or any other testicular or epididymal abnormalities that were reported during the scrotal US examination, were noted.Following the identification of scrotal calculi from the US reports, a total of 67 patients were contacted by phone, and 40 patients were interviewed. Subsequently, patients were asked whether they had any scrotal PURPOSEThe purpose of this study was to determine the frequency of scrotal calculi in men referred for scrotal ultrasonography (US), to identify any associated pathologies, and to investigate if any relationship exists between scrotal lithiasis and pain. MATERIALS AND METHODSThis was a retrospective study in which 4084 scrotal US examinations in 3435 men were eval...

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Section: Discussionmentioning

confidence: 99%

Prevalence of scrotal calculi and its relationship to pain

Tan

Ozcan²,

Karaoğlanoğlu³

et al. 2011

Diagn Interv Radiol

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“…The authors found 93% of the 41 men had at least 1 symptom of pelvic floor dysfunction. In subsequent pelvic floor testing using electromyography registration, 88% of patients had increased resting pelvic floor muscle tone with mean of 6.7 mV (normal <3.0 mV) (21). Men with a normal resting pelvic floor tone were significantly older than those with an increased resting tone (65.6 vs. 45.6 years, P=0.0001) which supported the possibility of pelvic floor dysfunction in younger men with chronic orchialgia (21).…”

Section: Diagnosis and Evaluationmentioning

confidence: 99%

Chronic orchialgia: epidemiology, diagnosis and evaluation

Sigalos

Pastuszak

2017

Transl. Androl. Urol.

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Chronic orchialgia is a vexing condition defined as chronic or intermittent scrotal pain lasting at least three months that significantly interferes with daily activities. There are currently no guidelines regarding the diagnosis and management of this condition despite it being the cause of 2.5–4.8% of urologic clinic visits. Men often present with chronic orchialgia in their mid to late 30s, although the condition can present at any age. A broad differential diagnosis of chronic orchialgia includes epididymitis, testicular torsion, tumors, obstruction, varicocele, epididymal cysts, hydrocele, iatrogenic injury following vasectomy or hernia repair, and referred pain from a variety of sources including mid-ureteral stone, indirect inguinal hernia, aortic or common iliac artery aneurysms, lower back disorders, interstitial cystitis, and nerve entrapment due to perineural fibrosis; approximately 25–50% of chronic orchialgia is idiopathic in nature. In such cases, it is reasonable to consider psychological and psychosocial factors that may be contributing to chronic pain. Invasive testing is not recommended in the work-up of chronic orchialgia.

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“…Most papers in the literature cite causes for chronic orchialgia such as post-vasectomy pain syndrome, inflammatory chronic epididymitis, trauma, tumor, torsion, diabetic neuropathy, vascular anomalies, postoperative scrotal pain, chronic prostatitis, and rarer causes such as schistosomiasis and tuberculous epididymitis (1,2,22). Psychosomatic components of chronic orchialgia are poorly understood and infrequently considered as a cause of physical pain.…”

Section: Psychosomatic Componentsmentioning

confidence: 99%

Psychological perspectives in the patient with chronic orchialgia

Lian¹,

Shah²,

Mueller³

et al. 2017

Transl. Androl. Urol.

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Chronic orchialgia is a challenging problem to both the practitioner and unhappy patient and may be a poorly understood manifestation of a potential variety of different discrete causes. Treatment options can be wide ranging and include conservative measures, medical therapy, in office treatments and surgical procedures. Research has primarily focused on these more concrete treatment options with little focus on the either co-morbid or causative psychological issues. By at least considering the potential psychological co-morbidities and stressors that may be associated with chronic orchialgia, physicians can better utilize a multi-modal approach to this vexing problem.

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Chronic Testicular Pain as a Symptom of Pelvic Floor Dysfunction

Abstract: Chronic testicular pain can be a symptom of pelvic floor overactivity, especially in younger patients. A diagnostic evaluation should be performed when no pathophysiology can be found.

Cited by 24 publications

References 24 publications

Prevalence of scrotal calculi and its relationship to pain

Prevalence of scrotal calculi and its relationship to pain

Chronic orchialgia: epidemiology, diagnosis and evaluation

Psychological perspectives in the patient with chronic orchialgia

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