Chronic Testicular Pain

It is often hard to know where to turn when experiencing health issues that can be embarrassing or uncomfortable to talk about. This is true when it comes to patients experiencing chronic testicular pain. Testicular pain often leads patients to have many tests, without providing any answers to the source of the pain. Besides the physical discomfort patients living with chronic testicular pain face, they often battle negative emotional and psychological side effects as well. Our surgeons at The Institute for Advanced Reconstruction understand that this experience can be devastating and are here to provide hope to those with chronic testicular pain.

Discussing your condition with your doctor may be challenging, but it is the first step towards finding treatment and resuming your everyday life.

What is chronic testicular pain?

Chronic Testicular Pain, or orchialgia, is defined as an intermittent or constant pain in the testicle or testicles, which lasts longer than three months and interferes significantly with the patient’s daily activities.

What are some common causes of chronic testicular pain?

Common causes of testicular pain include infection, testicular torsion, inguinal hernia, spermatocele, varicocele, trauma, and previous operations.  However – In 25-50% of patients, there is no obvious cause for the pain, so they fall in the spectrum of idiopathic chronic orchialgia.

How is chronic testicular pain diagnosed?

A medical diagnosis is established following a thorough review of medical history and physical examination to rule out other sources of pain, as well as appropriate laboratory work up and a scrotal ultrasound.  A critical diagnostic test is a spermatic block which helps determine if the problem is via a neurological pathway.

Do any conservative treatment options exist for this condition?

Initial treatment occurs via conservative management with the use of anti-inflammatory medications and antibiotics, followed by low dose anxiolytics as well as neuromodulating drugs.  As mentioned above, a spermatic cord block can be used for both diagnostic and therapeutic purposes. This nerve block may provide patients with temporary pain relief.

If the modalities above do not provide improvement, or patients are seeking a long-term treatment, surgical intervention has shown to provide reliable and successful results.

What surgical treatment is offered at The Institute for Advanced Reconstruction?

The surgical treatment offered by the surgeons at the Institute for Advanced Reconstruction is microsurgical denervation of the spermatic cord.

The spermatic cord is a bundle of vessels, nerves and ducts that run to and from the testes. Within the spermatic cord, there are nerves which supply sensation to the testes. Microsurgical denervation of the spermatic cord involves a minimally invasive procedure where these nerves are surgically cut. By stopping the signals sent by these nerves from the testicles to the brain, we are able to prevent “pain signals” and alleviate chronic testicular pain.

If the diagnostic work up shows additional peripheral nerves contributing to the pain, we can address these at the same time using standard nerve decompression or nerve reconstruction techniques.

What determines if a patient is a candidate for this procedure?

A patient may be excluded from this procedure if they are found to have other etiologies that are contributing to their pain as well as those patients that do not have a positive response to a spermatic cord block.  Patients that experience temporary pain relief following this block are ideal patients for microsurgical denervation of the spermatic cord.

What is recovery like?
The procedure is performed in an outpatient setting and recovery is minimal.  Patients can expect to have some discomfort initially, which will be managed by an oral pain medication with the ability to switch to over the counter pain medications after the first couple days. Patients will be advised to abstain from strenuous activity and heavy lifting for the first month with gradual increase to activity thereafter.

What are the benefits of the surgery?

Greater than 70% of patients have a profound relief in their pain with a remaining 20% having a partial improvement in pain.  Many patients are able to return to daily activities and live much more comfortably in their day to day lives.

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