Clinical Management of Chronic Testicular Pain

Abstract

Aim: To review the causes and principles and recent concepts in the management of testicular pain. Introduction: Chronic testicular pain is a common presenting symptom in genitourinary surgery. Due to increased awareness of testicular cancer and in men’s health more cases are likely to be referred. Material and Methods: A literature search was made for abstracts, original papers and review articles in the Cochrane Database, Medline and medical textbooks using the words ‘testicular pain’ and orchialgia to find the causes and mechanisms of testicular pain. The management and algorithm have been structured on evidence-based management strategies. Results: The management of chronic testicular pain remains essentially based on clinical assessment. In recent years there have been advances in the non-surgical management of testicular pain mainly because of the emergence of pain relief as a specialty. However, in some cases pain control is a problem and may ultimately conclude with orchiectomy. Conclusions: The management of chronic testicular pain includes a careful assessment of testicular and extratesticular causes. Relief of symptoms is not always possible and gaining an insight into the patient’s concerns and empathizing with their condition is paramount in helping them cope with their symptoms. Surgery should not be undertaken lightly for there is no guarantee that there will always be resolution of symptoms and the patient should be counseled accordingly.

A Clinical Study on Microsurgical Denervation of Spermatic Cord for Refractory Chronic Orchialgia

“…A basic work-up of CO should at least include a good history and physical examination, urinalysis (if positive, then also a urine culture), and scrotal ultrasound [7,16,17]. Parekattil et al [2] suggested a pain distribution classification system for patients with CO in order to better identify the location of pain.…”

Chronic Testicular Pain in Adult Men

“…Men with CTP demonstrate characteristics found in other chronic pain syndrome patients, such as reporting pain as their chief complaint, low correspondence between symptoms and objective medical findings, an association with psychosocial dysfunction, and a history of multiple, unsuccessful treatments (IOM, 2011;Kumar et al, 2010;Planken et al, 2010). This includes a "try anything" attitude that results in "an extraordinary number of interventions" (Egan & Krieger, 1997, p. 215) usually with a low success rate.…”

Low-Back Pain, Leg Pain, and Chronic Idiopathic Testicular Pain Treated with Chiropractic Care

“…1,2 The prevalence in the United Kingdom has been estimated at between 1% in the general population to as high as 15%-19% in postvasectomy patients. 1 Testicular pain can be acute or chronic.…”

“…4 Testicular pain may arise from the hip, ureter, abdominal viscera, and points of nerve entrapment including disc herniation and peripheral entrapment. 2 Unfortunately, many patients are found to have idiopathic testicular pain.…”