Management of Chronic Orchialgia: Challenges and Solutions – The Current Standard of Care

• Main Authors: Parekattil SJ, Ergun O, Gudeloglu A
• Format: Article
• Language: English
• Published: Dove Medical Press 2020-07-01
• Series: Research and Reports in Urology
• Subjects: testicular pain; denervation of the spermatic cord; scrotal content pain; groin pain; peri-spermatic cord cryoablation; botox; stimrouter
• Online Access: https://www.dovepress.com/management-of-chronic-orchialgia-challenges-and-solutions-ndash-the-cu-peer-reviewed-article-RRU

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, TurkeyCorrespondence: Sijo J ParekattilPUR Clinic and University of Central Florida, 2341 Golden Aster Street, Clermont, FL 34711, USATel [phone]Email [e-mail]: 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