Management of Chronic Orchialgia: Challenges and Solutions – The Current Standard of Care
Received 20 April 2020
Accepted for publication 18 June 2020
Published 2 July 2020 Volume 2020:12 Pages 199—210
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 3
Editor who approved publication: Dr Jan Colli
Sijo J Parekattil,1 Onuralp Ergun,2 Ahmet Gudeloglu2
1PUR Clinic and University of Central Florida, Clermont, FL, USA; 2Department of Urology, Hacettepe University, Ankara, Turkey
Correspondence: Sijo J Parekattil
PUR Clinic and University of Central Florida, 2341 Golden Aster Street, Clermont, FL 34711, USA
Tel +1 863-258-4999
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.
Keywords: testicular pain, denervation of the spermatic cord, scrotal content pain, groin pain, peri-spermatic cord cryoablation, botox, stimrouter
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