Sx
Chronic Testicular Pain
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Chronic Testicular Pain
, Chronic Scrotal Pain, Orchalgia
See Also
Acute Testicular Pain
History
Characteristics of
Testicular Pain
Duration of pain (chronic defined as >3 months)
Location of pain
May be unilateral or bilateral
Associated urologic symptoms
Hematuria
Hematospermia
Dysuria
Erectile Dysfunction
(
Impotence
)
Previous urologic surgery
Vasectomy
Genital
Trauma
Prior
Hernia Repair
Comorbid conditions
Major Depression
Causes
Idiopathic in 25% of cases
Intermittent
Testicular Torsion
Post-genitourinary surgery
Sperm
Granuloma
(post-
Vasectomy
)
Varicocele
Testicular Cancer
(painless in 60% of cases)
Genitourinary infection (e.g.
Sexually Transmitted Disease
)
Evaluation
Assessment for
Acute Testicular Pain
is critical
Assess for referred pain
Nephrolithiasis
in the mid-ureter (most common)
Radiculopathy
Genitofemoral and ilioinguinal nerves (T10-L1)
Causes
Inguinal Hernia
Radiculitis
Entrapment Neuropathy
after
Hernia Repair
Sperm
Granuloma
Signs
Complete
Male Genital Exam
including
Rectal Exam
Labs
Urinalysis
Urine Culture
Expressed Prostatic Secretion
s when indicated
Gonorrhea
and
Chlamydia
cultures
Radiology
Ultrasound
with color flow doppler of
Scrotum
Consider Spiral
CT Abdomen
or intravenous pyelogram
Management
Step 1
NSAID
s
Adjust
Posture
if due to radiculopathy
Empiric
Antibiotic
s for 2 weeks or more
Cover
Chlamydia
and
Ureaplasma
Doxycycline
Ciprofloxacin
Step 2
Spermatic cord block at pubic tubercle
Bupivicaine (
Marcaine
) 0.25% 3 ml and
Methylprednisolone
40 mg
Inject no more often than once monthly
Trascutaneous Electrical Nerve Stimulation (
TENS
)
Step 3
Multidisciplinary Pain Management
Antidepressant
medication
Psychotherapy
Step 4: Urologic Surgery
Orchiectomy
Surgical denervation
Testes
alon spermatic cord
References
Baum (1995) Postgrad Med 98(4):151-8 [PubMed]
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