Chronic Testicular Pain: A Review of Aetiology and Management

Romy Mondschein; Paul Manohar; Scott Donnellan; Devanayagam Manohar

doi:doi:10.11648/j.ijcu.20200402.17

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Chronic Testicular Pain: A Review of Aetiology and Management

Romy Mondschein, Paul Manohar, Scott Donnellan, Devanayagam Manohar

Published in International Journal of Clinical Urology (Volume 4, Issue 2)

Received: 11 August 2020 Accepted: 24 August 2020 Published: 16 September 2020

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Abstract

Chronic testicular pain affects a growing number of men worldwide. The approach to diagnosis and treatment is variable, resulting in treatment delays of reversible causes that may increase the probability of progression to chronic pain. A large proportion of men have no reversible cause identified and delayed recognition and management of this issue can cause significant morbidity. In this article, an approach to diagnosis and a review of treatment modalities available to manage chronic testicular pain is presented. Randomised control trials and current protocols for management were reviewed, in addition to case series and single-centre experiences of specialists with an interest in managing this condition. It is evident that chronic testicular pain should be managed with a multidisciplinary approach, to address the complex psychosocial elements often co-presenting with chronic pain. Various treatment options are available including medical therapy, non-invasive physiotherapy techniques and invasive surgical techniques. There is good evidence emerging for microsurgical techniques and nerve blocks. More research is required to determine the most effective duration and repetition of treatments. Chronic scrotal pain is physiologically related to other chronic pain syndromes and more research is required to determine the mechanisms behind this and potentially target chronic pain at a cellular level. In summary, chronic testicular pain affects a large number of men and further investigation into aetiology is important to direct treatment. A range of interventions are available -it is recommended that conservative treatments are trialed first in a multidisciplinary setting.

Published in	International Journal of Clinical Urology (Volume 4, Issue 2)
DOI	10.11648/j.ijcu.20200402.17
Page(s)	64-67
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2020. Published by Science Publishing Group

Keywords

Testicular Pain, Pelvic Pain, Chronic Pain, Men

References

[1]	Calixte N, Brahmbhatt J, Parekattil S. Chronic Testicular and Groin Pain: Pathway to Relief. Curr Urol Rep. 2017 Sep 02; 18 (10): 83.
[2]	Kavoussi PK, Castabile RA. Orchialgia and the chronic pelvic pain syndrome. World J Urol 2013, 31: 773-778.
[3]	Heidenreich A, Olbert P, Engelmann, U. Management of chronic testalgia by microsurgical testicular denervation. European Urology. 2002, 41, 392-397.
[4]	Quallich SA, Arlsanian-Engoren C. Chronic testicular pain in adult men: an integrative literature review. Am J Mens Health. 2013; 7 (5): 402–13.
[5]	Cassidy DJ. Early experience with microsurgical spermatic cord denervation for chronic orchialgia at a Canadian centre. Can Urol Assoc J. 2015; 9 (1–2): e72–4.
[6]	Davis BE, Noble MJ, Weigel JW, Foret JD, Mebust WK. Analysis and management of chronic testicular pain. J Urol. 1990, 143: 936-939.
[7]	Levine L. Chronic orchialgia: evaluation and discussion of treatment options. Ther Adv Urol. 2010, 2 (5-6) 209-214.
[8]	Cross SA. Pathophysiology of pain. Mayo Clin Proc. 1994, 69: 375-83.
[9]	Shaw A, Sharma M, Zibly Z, Ikeda D, Deogaonkar M. Sandwich technique, peripheral nerve stimulation, peripheral field stimulation and hybrid stimulation for inguinal region and genital pain, British Journal of Neurosurgery. 2016, 30: 6, 631-636.
[10]	Doubleday KL, Kulig K, Landel R. Treatment of testicular pain using conservative management of the thora- columbar spine: A case report. Archives of Physical Medicine and Rehabilitation. 2003, 84: 1903-1905.
[11]	Parekattil SJ, Gudeloglu A, Brahmbhatt JV, et al. Trifecta nerve complex: potential anatomical basis for microsurgical denervation of the spermatic cord for chronic orchialgia. J Urol 2013; 190: 265-70.
[12]	Baron R. Mechanisms of disease: neuropathic pain -a clinical perspective. Nat Clin Pract Neurol. 2006; 2: 95-106.
[13]	Bolay H, Moskowitz MA. Mechanisms of pain modulation in chronic syndromes. Neurology. 2002, 59: S2-S7.
[14]	(Patel AP. Anatomy and physiology of chronic scrotal pain. Transl Androl Urol 2017. 6: S51-S56.
[15]	Starke NR, Costabile RA. Medical management of chronic orchalgia. Transl Androl Urol 2017; 6: S48-50.
[16]	Pontari M. When to operate for scrotal pain. J Urol. 2013; 190: 13.
[17]	Granitsiotis P, Kirk D. Chronic testicular pain: an overview. Eur Urol. 2004; 45: 430-6.
[18]	Leslie SW, Sajjad H, Siref LE. Chronic Testicular Pain (Orchialgia) [Updated 2019 Oct 8]. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan.
[19]	Benson JS, Abern MR, Larsen S, Levine LA. Does a positive response to spermatic cord block predict response to microdenervation of the spermatic cord for chronic scrotal content pain? J Sex Med. 2013; 20 (3): 876–82.
[20]	Moore JR, Pathak RA, Snowden C, Bolan CW, Young PR, Broderick GA. Multispecialty retrospective review of the clinical utility of pelvic magnetic resonance imaging in the setting of pelvic pain. Transl Androl Urol. 2017; 6 (6): 1155–1158.
[21]	Strebel RT, Schmidt C, Beatrice J, et al. Chronic scrotal pain syndrome (CSPS): the widespread use of antibiotics is not justified. Andrology 2013; 1: 155-9.
[22]	Strebel RT, Leippold T, Luginbuehl T, et al. Chronic scrotal pain syndrome: management among urologists in Switzerland. Eur Urol 2005; 47: 812-6.
[23]	Sinclair AM, Miller B, Lee LK. Chronic orchalgia: consider gabapentin or nortriptyline before considering surgery. Int J Urol 2007; 14: 622-5.
[24]	Cui T, Terlecki R. Prevalence of Relative Deficiencies in Testosterone and Vitamin B12 Among Patients Referred for Chronic Orchialgia: Implications for Management. Am J Mens Health 2016.
[25]	Tantawy SA, Kamel DM, Abdelbasset WK. Does transcutaneous electrical nerve stimulation reduce pain and improve quality of life in patients with idiopathic chronic orchalgia? A randomised control trial. Journal of Pain Research 2018; 11: 77—82.
[26]	Clemens JQ, Nadler RB, Shaeffer AJ, et al. Biofeedback, pelvic floor re-education and bladder training for male chronic pain syndrome. Urology. 2000: 56 (6): 951-955.
[27]	Meacham K, Shepherd A, Mohapatra DP, Haroutounian S. Neuropathic pain: central vs. peripheral mechanisms. Curr Pain Headache Rep. 2017; 21: 28.
[28]	Ziegelmann MJ, Farrell MR, Levine LA. Evaluation and Management of Chronic Scrotal Content Pain-A Common Yet Poorly Understood Condition. Rev Urol. 2019; 21 (2-3): 74–84.).
[29]	Oomen RJ, Witjens AC, Van Wijck AJ, Grobbee DE, Lock TM. Prospective double-blind preoperative pain clinic screening before microsurgical denervation of the spermatic cord in patients with testicular pain syndrome. Pain. 2014; 155 (9): 1720–6.
[30]	Nouri KH, Brish EL. Spinal cord stimulation for testicular pain. Pain Med. 2011; 12: 1435–1438.
[31]	Lowe, Gregory. “Extirpative surgery for chronic orchialgia: is there a role?” Translational andrology and urology vol. 6, Suppl 1 (2017): S2-S5.
[32]	Davis BE, Noble MJ, Weigel JW, et al. Analysis and management of chronic testicular pain. J Urol 1990; 143: 936-9.
[33]	Costabile RA, Hahn M, McLeod DG. Chronic orchialgia in the pain prone patient: the clinical perspective. J Urol 1991. 146: 1571-4.

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APA Style

Romy Mondschein, Paul Manohar, Scott Donnellan, Devanayagam Manohar. (2020). Chronic Testicular Pain: A Review of Aetiology and Management. International Journal of Clinical Urology, 4(2), 64-67. https://doi.org/10.11648/j.ijcu.20200402.17

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ACS Style

Romy Mondschein; Paul Manohar; Scott Donnellan; Devanayagam Manohar. Chronic Testicular Pain: A Review of Aetiology and Management. Int. J. Clin. Urol. 2020, 4(2), 64-67. doi: 10.11648/j.ijcu.20200402.17

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AMA Style

Romy Mondschein, Paul Manohar, Scott Donnellan, Devanayagam Manohar. Chronic Testicular Pain: A Review of Aetiology and Management. Int J Clin Urol. 2020;4(2):64-67. doi: 10.11648/j.ijcu.20200402.17

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@article{10.11648/j.ijcu.20200402.17,
  author = {Romy Mondschein and Paul Manohar and Scott Donnellan and Devanayagam Manohar},
  title = {Chronic Testicular Pain: A Review of Aetiology and Management},
  journal = {International Journal of Clinical Urology},
  volume = {4},
  number = {2},
  pages = {64-67},
  doi = {10.11648/j.ijcu.20200402.17},
  url = {https://doi.org/10.11648/j.ijcu.20200402.17},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijcu.20200402.17},
  abstract = {Chronic testicular pain affects a growing number of men worldwide. The approach to diagnosis and treatment is variable, resulting in treatment delays of reversible causes that may increase the probability of progression to chronic pain. A large proportion of men have no reversible cause identified and delayed recognition and management of this issue can cause significant morbidity. In this article, an approach to diagnosis and a review of treatment modalities available to manage chronic testicular pain is presented. Randomised control trials and current protocols for management were reviewed, in addition to case series and single-centre experiences of specialists with an interest in managing this condition. It is evident that chronic testicular pain should be managed with a multidisciplinary approach, to address the complex psychosocial elements often co-presenting with chronic pain. Various treatment options are available including medical therapy, non-invasive physiotherapy techniques and invasive surgical techniques. There is good evidence emerging for microsurgical techniques and nerve blocks. More research is required to determine the most effective duration and repetition of treatments. Chronic scrotal pain is physiologically related to other chronic pain syndromes and more research is required to determine the mechanisms behind this and potentially target chronic pain at a cellular level. In summary, chronic testicular pain affects a large number of men and further investigation into aetiology is important to direct treatment. A range of interventions are available -it is recommended that conservative treatments are trialed first in a multidisciplinary setting.},
 year = {2020}
}

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TY - JOUR
T1 - Chronic Testicular Pain: A Review of Aetiology and Management
AU - Romy Mondschein
AU - Paul Manohar
AU - Scott Donnellan
AU - Devanayagam Manohar
Y1 - 2020/09/16
PY - 2020
N1 - https://doi.org/10.11648/j.ijcu.20200402.17
DO - 10.11648/j.ijcu.20200402.17
T2 - International Journal of Clinical Urology
JF - International Journal of Clinical Urology
JO - International Journal of Clinical Urology
SP - 64
EP - 67
PB - Science Publishing Group
SN - 2640-1355
UR - https://doi.org/10.11648/j.ijcu.20200402.17
AB - Chronic testicular pain affects a growing number of men worldwide. The approach to diagnosis and treatment is variable, resulting in treatment delays of reversible causes that may increase the probability of progression to chronic pain. A large proportion of men have no reversible cause identified and delayed recognition and management of this issue can cause significant morbidity. In this article, an approach to diagnosis and a review of treatment modalities available to manage chronic testicular pain is presented. Randomised control trials and current protocols for management were reviewed, in addition to case series and single-centre experiences of specialists with an interest in managing this condition. It is evident that chronic testicular pain should be managed with a multidisciplinary approach, to address the complex psychosocial elements often co-presenting with chronic pain. Various treatment options are available including medical therapy, non-invasive physiotherapy techniques and invasive surgical techniques. There is good evidence emerging for microsurgical techniques and nerve blocks. More research is required to determine the most effective duration and repetition of treatments. Chronic scrotal pain is physiologically related to other chronic pain syndromes and more research is required to determine the mechanisms behind this and potentially target chronic pain at a cellular level. In summary, chronic testicular pain affects a large number of men and further investigation into aetiology is important to direct treatment. A range of interventions are available -it is recommended that conservative treatments are trialed first in a multidisciplinary setting.
VL - 4
IS - 2
ER -

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Author Information

Romy Mondschein

Department of Surgery, Monash Health, Victoria, Australia
Paul Manohar

Department of Surgery, Monash University, Victoria, Australia
Scott Donnellan

Department of Surgery, Monash Health, Victoria, Australia
Devanayagam Manohar

Liverpool Hospital, Sydney, Australia

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Plain Text BibTeX RIS

APA Style

Romy Mondschein, Paul Manohar, Scott Donnellan, Devanayagam Manohar. (2020). Chronic Testicular Pain: A Review of Aetiology and Management. International Journal of Clinical Urology, 4(2), 64-67. https://doi.org/10.11648/j.ijcu.20200402.17

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ACS Style

Romy Mondschein; Paul Manohar; Scott Donnellan; Devanayagam Manohar. Chronic Testicular Pain: A Review of Aetiology and Management. Int. J. Clin. Urol. 2020, 4(2), 64-67. doi: 10.11648/j.ijcu.20200402.17

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AMA Style

Romy Mondschein, Paul Manohar, Scott Donnellan, Devanayagam Manohar. Chronic Testicular Pain: A Review of Aetiology and Management. Int J Clin Urol. 2020;4(2):64-67. doi: 10.11648/j.ijcu.20200402.17

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@article{10.11648/j.ijcu.20200402.17,
  author = {Romy Mondschein and Paul Manohar and Scott Donnellan and Devanayagam Manohar},
  title = {Chronic Testicular Pain: A Review of Aetiology and Management},
  journal = {International Journal of Clinical Urology},
  volume = {4},
  number = {2},
  pages = {64-67},
  doi = {10.11648/j.ijcu.20200402.17},
  url = {https://doi.org/10.11648/j.ijcu.20200402.17},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijcu.20200402.17},
  abstract = {Chronic testicular pain affects a growing number of men worldwide. The approach to diagnosis and treatment is variable, resulting in treatment delays of reversible causes that may increase the probability of progression to chronic pain. A large proportion of men have no reversible cause identified and delayed recognition and management of this issue can cause significant morbidity. In this article, an approach to diagnosis and a review of treatment modalities available to manage chronic testicular pain is presented. Randomised control trials and current protocols for management were reviewed, in addition to case series and single-centre experiences of specialists with an interest in managing this condition. It is evident that chronic testicular pain should be managed with a multidisciplinary approach, to address the complex psychosocial elements often co-presenting with chronic pain. Various treatment options are available including medical therapy, non-invasive physiotherapy techniques and invasive surgical techniques. There is good evidence emerging for microsurgical techniques and nerve blocks. More research is required to determine the most effective duration and repetition of treatments. Chronic scrotal pain is physiologically related to other chronic pain syndromes and more research is required to determine the mechanisms behind this and potentially target chronic pain at a cellular level. In summary, chronic testicular pain affects a large number of men and further investigation into aetiology is important to direct treatment. A range of interventions are available -it is recommended that conservative treatments are trialed first in a multidisciplinary setting.},
 year = {2020}
}

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