<p>Management of Chronic Orchialgia: Challenges and Solutions – The Current Standard of Care</p>

Abstract

Introduction Chronic 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. Methods A 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. Results This 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). Conclusion A structured and evidence-based approach to help urologists manage patients with chronic orchialgia or scrotal content pain is presented.

Postvaricocele Embolization Pain Syndrome: A Case Series Report and Review of Current Treatment Strategies

“…The management of chronic orchialgia is challenging due to the potential multifactorial causes, including ensuing psychological distress and opiate dependency. [29][30][31][32] Treatment strategies often involve a stepwise approach from the initial conservative measures and/or various neuromodulation techniques (such as pelvic floor therapy, acupuncture, pain clinic) to surgical interventions, including targeted nerve blocks, MSCD, perispermatic cord and/or ilioinguinal botox or cryoablation as well as inguinal orchiectomy. In our study, all the patients have tried various medical therapies and only 2 patients on conservative measures reported better pain control after 3 years postembolization.…”

Chronic Orchialgia Stemming From Lumbar Disc Herniation: A Case Report and Brief Review

“…These changes are termed neural plasticity and manifest as allodynia or hyperalgesia (Patel, 2017). Parekattil et al (2020) have observed that a significant number of patients with chronic orchialgia have Wallerian degeneration in their spermatic cords when compared to the general male population. The ligation, ablation, or neuro-modulation of the affected nerve fibers may be considered as relevant approaches for pain relief in chronic orchialgia (Parekattil et al, 2020).…”

Scrotal Pain after Varicocelectomy: A Narrative Review

“…Stimulation of the peripheral nerves or the spinal cord [ 54 , 55 , 56 ] and cryoablation of tissue innervation around the spermatic cord have been reported to relieve chronic scrotal pain [ 57 ].…”