Management of chronic orchialgia: review of current clinical practice

摘要

Abstract: Chronic orchialgia (CO) or chronic scrotal pain (CSP) has been defined as greater than 3 months of unilateral or bilateral scrotal pain that leads to the pursuit of treatment. Classic symptoms include dull pain that originates anywhere from the lower abdomen to the scrotum/glans penis and is a frustrating disease that decreases the quality of life (QoL) tremendously. It is challenging to treat the disease since the pathophysiology and the etiology are not fully understood and there is lack of structured, evidence-based treatment schemes to guide the physician. This article reviews the current literature, shares the surgical techniques and our own experience with thousands of CO patients to provide the latest advancements in the management of this debilitating disease in addition to an algorithm to help the urologist plan the patient’s treatment. The algorithm consists of a structured approach starting from conservative therapies and spermatic cord block the outcomes of which act as a surrogate to predict the success of further invasive treatments. There are various reported success rates for the modalities discussed in this algorithm and include microsurgical denervation of the spermatic cord (77–100%), ultrasound guided peri spermatic cord cryoablation (59–75%), radical orchiectomy (20–75%), targeted robotic intra-abdominal denervation (71%) and alternate therapies.