Pulsed Radiofrequency Ablation for Orchialgia-A Literature Review.

Pulsed radiofrequency, short bursts of radiofrequency energy, has been used by pain practitioners as a non- or minimally neurodestructive technique, an alternative to radiofrequency heat lesions. The clinical advantages and mechanisms of this treatment remain unclear. To review the current clinical implication of the pulsed radiofrequency technique for male patients with chronic scrotal pain. We systematically searched the English literature available at the EMBASE, MEDLINE/PubMed, Google Scholar, and Cochrane Library from inception to 22 November 2022. Only reports on a pulsed radiofrequency application on male patients with chronic scrotal pain were included. The final analysis yielded six reports on the clinical use of pulsed radiofrequency applications in male patients with chronic scrotal pain: six full publications, three case reports, one case series, one prospective uncontrolled pilot study, and one prospective randomized, controlled clinical trial. The accumulation of these data shows that using pulsed radiofrequency generates an increasing interest in pain physicians, radiologists, and urologists for managing chronic scrotal pain. No side effects related to the pulsed radiofrequency technique were reported to date. Further research on the clinical and biological effects is justified. Large sample sizes and randomized clinical trials are warranted.

Non-pharmacological treatments for chronic orchialgia: A systemic review.

OBJECTIVE: : To review the outcomes of various therapeutic modalities that can be offered to patients with chronic orchialgia (CO) after failed conservative treatment. METHODS: : A literature search was conducted using the PubMed and MEDLINE databases searching for articles exploring different CO treatment modalities. A Preferred Reporting Items for Systematic Reviews and Meta-Analyses approach was used to report the results of the literature search. RESULTS: : A total of 34 studies were included for qualitative analysis. Most of the studies explored microsurgical spermatic cord denervation (MSCD; n = 19). Eight studies involved devices and interventions directed at blocking nerve sensations (pulsed radiofrequency stimulation, n = 5; transcutaneous electrical nerve stimulation, n = 1; cryoablation, n = 1; and mechanical vibratory stimulation, n = 1). Five studies reported on vasectomy reversal as a modality to relieve post-vasectomy pain syndrome (PVPS), while two studies explored the outcomes of orchidectomy on pain relief in patients with CO. CONCLUSION: : Several treatment methods are available in the urologist's armamentarium for the treatment of CO. MSCD appears to be an appealing treatment modality with encouraging outcomes. Neuropathic pain can be managed with a number of relatively non-invasive modalities. Vasectomy reversal is a sound treatment approach for patients with PVPS and ultimately orchidectomy is a terminal approach that can be discussed with patients suffering from intractable pain.

Chronic Scrotal Content Pain: a Review of the Literature and Management Schemes.

PURPOSE OF REVIEW: Chronic scrotal content pain (CSCP) is a complex condition with multiple etiologies that requires a thorough understanding of its pathophysiology, workup, and treatment options. We performed a comprehensive and contemporary review to augment our current understanding of CSCP. RECENT FINDINGS: We discuss new advances in CSCP-specific pain questionnaires, modern studies of microscopic spermatic cord denervation and its variations, and novel techniques including electric nerve stimulation and cryoablation in addition to randomized control trials with significant negative findings. We also present literature focusing on the prevention of CSCP secondary to surgical iatrogenic causes. The constantly evolving literature of CSCP has led to the significant evolution in its diagnosis and treatment, from oral medications to salvage options after microscopic spermatic cord denervation. With each advance, we come closer to developing a more thorough, evidence-based algorithm to guide urologists in treatment of CSCP.

Targeted Microsurgical Denervation of the Spermatic Cord for Chronic Orchialgia: the Current Standard of Care.

PURPOSE OF REVIEW: This paper reviews the pathophysiology, current literature, techniques for full microsurgical denervation (MDSC) and targeted microsurgical denervation (TMDSC) of the spermatic cord, and outcomes for these treatment options for patients with chronic scrotal content pain (CSCP) or orchialgia. RECENT FINDINGS: Significant reduction in pain (77-100%) is reported across various studies for CSCP patients with minimal patient morbidity. The testicular atrophy/loss risk is less than 1%. Testosterone levels do not appear to be affected by TMDSC/MDSC. The outcomes between TMDSC and MDSC are comparable (not statistically significantly different). However, TMDSC is significantly more efficient and a lot less tedious to perform. TMSCD had a shorter microsurgical operative time (21 min vs 53 min, P = 0.0001) than MDSC. Targeted or full microsurgical denervation of the spermatic cord is a safe and effective treatment option that is well published across several studies. The targeted MDSC approach is a more efficient and potentially less risky approach with similar outcomes to full MDSC.

Terazosin or baclofen in young men with chronic orchialgia: A cohort study of 499 patients.

PURPOSE: We aimed to investigate the comparative efficacy of terazosin and baclofen in young men with chronic orchialgia using National Institutes of Health Chronic Prostatitis Symptom Index measurement. PATIENTS AND METHODS: Of 499 young men with chronic orchialgia, 255 received a daily 2 mg terazosin at bedtime and 244 received 10 mg baclofen during a period of 3 months. A daily 10-min hot-tub hip-bath rest was administered for all patients. Moreover, all patients with grade 3 and 18 patients with grade 2 varicocele underwent varicocelectomy. The National Institutes of Health Chronic Prostatitis Symptom Index score was assessed at baseline and 3 months later. RESULTS: Both terazosin and baclofen groups experienced a significant reduction in mean National Institutes of Health Chronic Prostatitis Symptom Index score (24.78 and 24.81 at baseline to 19.68 and 19.60 after the treatment for terazosin and baclofen groups, respectively). However, there was no significant difference between the groups with regard to post-treatment National Institutes of Health Chronic Prostatitis Symptom Index score after adjustment for the pre-treatment score (p = 0.987). A total of 85 patients (33.4%) in terazosin group and 74 patients (30.3%) in baclofen group underwent varicocelectomy. Addition of the varicocelectomy to the treatment as a multimodal approach had no further improvement in the National Institutes of Health Chronic Prostatitis Symptom Index score. CONCLUSION: Although a significant reduction was observed in mean National Institutes of Health Chronic Prostatitis Symptom Index score for both terazosin and baclofen groups, there was no significant difference between the treatments. Moreover, addition of varicocelectomy to terazosin or baclofen could not significantly decrease National Institutes of Health Chronic Prostatitis Symptom Index score; thus, varicocelectomy may not be appropriate for men who have some success with medical management. Further randomized studies are warranted.

Chronic scrotal pain may lead to reduced sexual function and interest, while sexual activity may worsen chronic scrotal pain: "double jeopardy".

BACKGROUND: While it is recognized that chronic pain may adversely impact sexual function and activity in men and we also recognize that sexual activity may worsen the pain for men with chronic scrotal pain (CSP), the effect on sexual functioning and conversely the impact of sex on CSP has not previously been documented. METHODS: Retrospective analysis of a prospectively collected database. RESULTS: From Feb 2014 to Sep 2015, a total of 128 men presenting for assessment of CSP completed all or parts of a standardized questionnaire. Overall 60% (69/116) of the men felt that the CSP had kept them either a "lot" or "some" of the time from sexual activity and 64% (27/43) had evidence of decreased erectile performance. Those with more severe pain (analog pain scores 7-10/10) had more significant sexual dysfunction than those with less severe pain, with 54% (45/83) vs. 0% (0/33, P<0.01: Fisher's exact test) noting that the pain kept them from sexual activity "a lot" and 70% (23/33) vs. 40% (4/10, P<0.01) noting sexual dysfunction. Diminished libido was also common in the men [43% (55/128)] as were the symptoms of testosterone deficiency [76% (97/128)]. Conversely, sexual activity often exacerbated the pain, with 37% (47/128) finding that ejaculation aggravated their pain and another 38% (48/128) patients found sexual activity aggravated their pain. CONCLUSIONS: Men with severe CSP have significantly reduced sexual function and interest compared to men with moderate or minor levels of pain. The majority of men with CSP who were sexually active were faced with worsening pain with sex and ejaculation. Clinicians should be aware of the twin risks of sexual dysfunction occurring in men with CSP and sexual activity worsening the severity of the CSP.

Chronic Testicular and Groin Pain: Pathway to Relief.

The management of patients suffering with chronic testicular and groin pain is very challenging. With increased awareness of men's health, more patients and clinicians are open to talk about this complex problem that affects over 100,000 men/year. The pathogenesis of chronic orchialgia is still not clear, but there are several postulated theories. Treatment options include conservative medical therapy with NSAIDs, antidepressants, anticonvulsants, and narcotics. Surgical options such as targeted microsurgical denervation and microcryoablation can provide permanent durable pain relief. The goal of this article is to review and discuss the management of patients with chronic orchialgia using currently available literature.

Extirpative surgery for chronic orchialgia: is there a role?

Chronic orchialgia is a difficult and frustrating condition for both the patient and clinician. Determining appropriate course of therapy should require extensive conservative measures and consideration of alternative surgical options prior to concluding an orchiectomy is warranted. This manuscript aims to provide the clinician with the information currently available to determine if the anticipated success rate is warranted to consider extirpative surgery for idiopathic chronic orchialgia.

Robot-assisted microsurgery for chronic orchialgia.

Chronic orchialgia is one of the most common complaints seen in the urologists office and has traditionally been considered a very difficult diagnostic and therapeutic challenge for the clinician. First line management of chronic orchialgia is conservative treatment; however, in men who fail conservative therapy, surgical intervention may be indicated. Microsurgery has been the mainstay for surgical treatment of chronic orchialgia, but the implementation of robotics to microsurgery lends itself particularly to surgical treatment of chronic orchialgia. PubMed was used to perform a current literature search on chronic orchialgia with robotic microsurgery, robotic spermatic cord denervation, robotic varicocelectomy, and robotic vasectomy reversal. Although conservative therapy is considered the first line treatment for chronic orchialgia, reported outcomes are moderate to poor, with the need to proceed to surgical intervention in select cases. Current surgical therapies in which robot assistance have been applied to microsurgery include microsurgical denervation of the spermatic cord, varicocelectomy, and vasectomy reversal. As further studies have assisted in the understanding of surgical treatment of chronic orchialgia, the application of robot assistance to this level of microsurgery has been shown to be feasible and safe with comparable outcomes to traditional microsurgery and may provide potential advantages.

Chronic orchialgia: epidemiology, diagnosis and evaluation.

Chronic orchialgia is a vexing condition defined as chronic or intermittent scrotal pain lasting at least three months that significantly interferes with daily activities. There are currently no guidelines regarding the diagnosis and management of this condition despite it being the cause of 2.5-4.8% of urologic clinic visits. Men often present with chronic orchialgia in their mid to late 30s, although the condition can present at any age. A broad differential diagnosis of chronic orchialgia includes epididymitis, testicular torsion, tumors, obstruction, varicocele, epididymal cysts, hydrocele, iatrogenic injury following vasectomy or hernia repair, and referred pain from a variety of sources including mid-ureteral stone, indirect inguinal hernia, aortic or common iliac artery aneurysms, lower back disorders, interstitial cystitis, and nerve entrapment due to perineural fibrosis; approximately 25-50% of chronic orchialgia is idiopathic in nature. In such cases, it is reasonable to consider psychological and psychosocial factors that may be contributing to chronic pain. Invasive testing is not recommended in the work-up of chronic orchialgia.

Genital pain: algorithm for management.

Chronic testicular pain although becoming very common in our patient population poses a challenge to the physician, the patient and his family. The pathogenesis of chronic orchialgia (CO) is not well understood. The objective of this paper is to review the current literature on chronic testicular pain and its management and to propose an algorithm for its treatment. Abstracts, original papers and review articles were reviewed during a literature search using words such as testicular pain, CO, and microsurgical anatomy of spermatic cord. Chronic scrotal content pain (CSP) is a difficult condition to treat and could be idiopathic or secondary. Conservative therapy is the first line of treatment attempted to allow the patient to return to his routine activities. When conservative treatment fails, patients can now turn toward surgical options such as microsurgical denervation of the spermatic cord (MDSC) which has a success rate published in the 60-85% range and/or minimally invasive therapies such as microcryoablation of the spermatic cord, Botox or Amniofix injection. There is an increase in referrals for CO. The true pathogenesis is still unclear and the road to complete recovery is unsure for certain patients. This paper proposes an algorithm for the management of patients suffering with CO.

Quality of life in men with chronic scrotal pain.

Background: Chronic scrotal pain (CSP) is a common and often debilitating condition found in up to 4.75% of men. There is little written on the impact of CSP on men's lives. Aim: The aim of this study was to understand the impact of CSP on men's lives. Methods: Patients with CSP were prospectively asked to complete a comprehensive questionnaire, including questions on quality of life (QoL), activities, and mood. Results: The mean age of the 131 patients was 43 years. Pain was intermittent, with severe pain episodes (mean pain scores 7.2 ± 2 out of 10) affecting men on average 40% ± 30% of the time. Overall, 88/131 (67.17%) of patients responded that they felt "unhappy" or "terrible" with their present situation. More than 40% of patients complained of depressive symptoms more than half the days of the month. Normal activities were adversely affected, with 68/131 (51.90%) reporting limited ability to work, 93/131 (70.99%) patients reporting decreased physical activity, and 81/131(61.83%) reporting decreased sexual activity. Comparing men with pain levels ≥ 7/10 vs. those with pain levels < 7/10, 47% (41/88) vs. 8.1% (3/37) reported that they felt "terrible," 40% (35/88) vs. 13% (5/38) had depressive feelings more than half the time, and 35% (28/80) vs. 16% (6/38) felt little pleasure doing things (P < 0.01 for all). Conclusion: Our study suggests that QoL, mood, and the ability to perform normal activities are profoundly disturbed in CSP patients and that the pain severity is directly related to QoL.

Contexte: La douleur scrotale chronique est une affection commune et souvent débilitante dont souffrent près de 4,75 % des hommes. Il y a peu d'écrits sur l'impact de la douleur scrotale chronique sur la vie des hommes.But: Comprendre l'impact de la douleur scrotale chronique sur la vie des hommes.Méthodes: On a demandé de manière prospective à des patients souffrant de douleur scrotale chronique de remplir un questionnaire détaillé comprenant des questions sur leur qualité de vie, leurs activités et leur humeur.Résultats: L'âge moyen des 131 patients était de 43 ans. La douleur était intermittente, comportait des épisodes de douleur intense (scores de la douleur moyens 7,2 +/- 2 sur 10) et affectait les hommes 40 % +/- 30 % du temps. Globalement, 88/131 (67,17 %) des patients ont répondu qu'ils se sentaient malheureux ou « horriblement mal ¼ en raison de leur situation actuelle. Plus de 40 % des patients se sont plaints de symptômes de dépression plus de la moitié des jours du mois. Leurs activités habituelles étaient affectées négativement, alors que 68/131 (51,90 %) disaient avoir une capacité de travail limitée, que 93/131 (70,99 %) des patients signalaient une diminution de leur activité physique et que 81/131 (61,83 %) d'entre eux faisaient état d'une diminution de leur activité sexuelle. La comparaison des hommes qui avaient un niveau de douleur ≥ 7/10 à ceux qui avaient un niveau de douleur < 7/10 a révélé que 47 % d'entre eux (41/88) se sentaient « horriblement pas bien ¼ contre 8,1 % (3/37), que 40 % (35/88) avaient des sentiments dépressifs plus de la moitié du temps contre 13 % (5/38) et que 35 % (28/80) ressentaient peu de plaisir à faire les choses contre 16 % (6/38) (p < 0,01 pour tous).Conclusion: Notre étude suggère que la qualité de vie, l'humeur et la capacité à vaquer à ses activités habituelles sont profondément perturbées chez les patients qui souffrent de douleur scrotale chronique et que l'intensité de la douleur est directement liée à la qualité de vie.

[Expressions of TRPV1 and TRPA1 in the dorsal root ganglion in the rat model of orchialgia].

OBJECTIVE: To explore the expressions of transient receptor potential vanilloid 1 (TRPV1) and TRP ankyrin 1 (TRPA1) in the dorsal root ganglion (DRG) and their action mechanisms in the rat model of orchialgia. METHODS: The models of orchialgia were established in male SD rats by injection of 2% acetic acid into the testis. Then the number of spontaneous pain responses and withdrawal latency in the model rats were recorded by behavioral tests and the expressions of TRPV1 and TRPA1 in T13－L1 DRGs determined by RT-qPCR, Western blot and immunofluorescence staining. RESULTS: Compared with the normal control rats, the orchialgia models showed a significant increase in the number of spontaneous pain responses (0.13 ± 0.35 vs 22.63 ± 3.42, P<0.01) and a decrease in the withdrawal latency at 4 hours after injection (ï¼»12.75 ± 1.50ï¼½ vs ï¼»4.85 ± 1.00ï¼½ s, P<0.05). The mRNA expressions of both TRPV1 and TRPA1 were observed in the membrane of the neurons in the DRG, the former increased by 1.77 times and the latter by 1.75 times that of the control (P<0.05). CONCLUSIONS: The expressions of TRPV1 and TRPA1 were up-regulated in the DRG of the rat models of orchialgia, which may be involved in the allodynia and hyperalgesia of the rats.

Chronic orchialgia: Review of treatments old and new.

INTRODUCTION: Chronic orchialgia is historically and currently a challenging disease to treat. It is a diagnostic and therapeutic challenge for physicians. Conservative therapy has served as the first line of treatment. For those who fail conservative therapy, surgical intervention may be required. We aim to provide a review of currently available surgical options and novel surgical treatment options. METHODS: A review of current literature was performed using PubMed. Literature discussing treatment options for chronic orchialgia were identified. The following search terms were used to identify literature that was relevant to this review: Chronic orchialgia, testicular pain, scrotal content pain, and microsurgical denervation of the spermatic cord (MDSC). RESULTS: The incidence of chronic orchialgia has been increasing over time. In the USA, it affects up to 100,000 men per year due to varying etiologies. The etiology of chronic orchialgia can be a confounding problem. Conservative therapy should be viewed as the first line therapy. Studies have reported poor success rates. Current surgical options for those who fail conservative options include varicocelectomy, MDSC, epididymectomy, and orchiectomy. Novel treatment options include microcryoablation of the peri-spermatic cord, botox injection, and amniofix injection. CONCLUSION: Chronic orchialgia has been and will continue to be a challenging disease to treat due to its multiple etiologies and variable treatment outcomes. Further studies are needed to better understand the problem. Treatment options for patients with chronic orchialgia are improving. Additional studies are warranted to better understand the long-term durability of this treatment options.

Prospective double-blind preoperative pain clinic screening before microsurgical denervation of the spermatic cord in patients with testicular pain syndrome.

Testicular pain syndrome (TPS), defined as an intermittent or constant pain in one or both testicles for at least 3 months, resulting in significant reduction of daily activities, is common. Microsurgical denervation of the spermatic cord (MDSC) has been suggested as an effective treatment option. The study population comprised 180 TPS patients admitted to our outpatient urology clinic between 1999 and 2011. On 3 different occasions, patients were offered a double-blind, placebo-controlled temporary blockade of the spermatic cord. A single blockade consisted of 10 mL 2% lidocaine, 10 mL 0.25% bupivacaine, or 10 mL 0.9% sodium chloride. If the results of these blockades were positive, MDSC was offered. All MDSCs were performed by a single urologist (M.T.W.T.L.) using an inguinal approach. Pain reduction was determined at prospective follow-up. This study evaluated 180 patients. Most patients (61.1%) had undergone a scrotal or inguinal procedure. Patients had complaints during sexual activities (51.7%), sitting (37.5%), and/or cycling (36.7%); 189 randomized blockades were offered to all patients. There was a positive response in 37% and a negative response in 51%. MDSC was performed on 58 testicular units, including 3 patients with a negative outcome of the blockades. At mean follow-up of 42.8 months, 86.2% had a ≥ 50% reduction of pain and 51.7% were completely pain free. MDSC is a valuable treatment option for TPS patients because in this study 86.2% experienced a ≥ 50% reduction of pain. To prevent superfluous diagnostics and treatment, it is mandatory to follow a systematic protocol in the treatment of TPS.

Chronic unexplained orchialgia: a concept analysis.

AIMS: To conduct an analysis of the concept of chronic unexplained orchialgia. BACKGROUND: Chronic unexplained orchialgia is a concept unique to men's health; however, clarity is lacking regarding the precise meaning of the key attributes of this important concept. DESIGN: Walker and Avant's framework was used to guide this concept analysis. DATA SOURCES: Literature sources included bibliographic databases. REVIEW METHODS: Literature published in English from January 1970 to December 31, 2012 was reviewed. Thematic analysis identified critical attributes, antecedents and consequences of the concept. RESULTS: Based on the analysis, a contemporary definition for chronic unexplained orchialgia is proposed, rooted in the concept of chronic pain. This definition is based on the concept analysis and the defining attributes that were identified in the literature. Chronic unexplained orchialgia is a subjective negative experience of adult men, perceived as intermittent or continuous pain of variable intensity, present at least three months, localizing to the testis(es) in the absence of objective organic findings and that interferes with quality of life. CONCLUSION: This analysis provides a precise definition for chronic unexplained orchialgia and distinguishes it from other similar terms. This concept analysis provides conceptual clarity that can guide understanding and development of a conceptual framework, middle range theory, or situation-specific theory. Further exploration of this concept is recommended to uncover the influence of social, sexual and cultural factors.

Chronic testicular pain in adult men: an integrative literature review.

Past investigations of chronic testicular pain provide a sparse representation of the men with this condition and lack key details to aid our understanding of this important men's health condition. As a chronic pain syndrome, more research is necessary to understand the phenomenon of chronic testicular pain and the pain experience of these men. This integrative literature review provides a summary of the current state of the science of chronic testicular pain in men, identifies the gaps in our knowledge, and provides recommendations to address this knowledge gap.

Chronic orchialgia: evaluation and discussion of treatment options.

Virtually all practicing urologists will encounter patients with a complaint of chronic testicular pain. This can be a frustrating process for both patient and physician, as there is no clearly established effective treatment regimen, nor is there a recognized and accepted standard protocol for evaluation. Many of these patients will see multiple physicians during the course of their evaluation, further increasing their frustration and potentially straining the physician/patient relationship. The etiology of testicular pain is varied and is frequently idiopathic. Easily recognized and reversible causes include spermatocele, tumor, infection, varicocele, and torsion. Chronic orchialgia has been defined as at least 3 months of chronic or intermittent pain. Although the diagnosis of chronic orchialgia is frequently given to these patients, it should be recognized that fairly frequently the patient will not have just testicular pain, but may have pain involving the epididymis, vas deferens, or adjacent paratesticular structures. Therefore a more appropriate term would be chronic scrotal content pain. This article reviews the current understanding of chronic scrotal content pain, reviewing the etiology, evaluation, and then a systematic review of the published literature on treatment. It should be recognized that the majority of the published literature are cohort studies with limited numbers of patients, rarely placebo-controlled, and without a uniform standard evaluation. Microdenervation of the spermatic cord is emerging as a reasonable and effective outpatient surgical technique to resolve chronic scrotal content pain, and successful results appear to be predicted by a temporary but complete response to a spermatic cord block.