madman
Super Moderator
Abstract
The management of pain is a complex condition that will be encountered by most practicing clinicians. In the genitourinary community, testicular pain may be classified as acute or chronic. Initial evaluation of chronic groin and scrotal content pain (CGSCP) begins with a detailed history and physical examination to elucidate the presenting pathology. Multiple therapy algorithms have been proposed with no definitive consensus; however, most begin with conservative intervention and medical management prior to advancing to more invasive procedures. Surgical approaches may range from reconstruction, as in vasovasostomy for post-vasectomy pain syndrome, to excision of the offending agent, as in epididymectomy. This review seeks to focus on chronic pain in the genitourinary community and review techniques of pain management in the current intervention for orchialgia, as well as identify future methods of treatment.
Introduction
Orchialgia is a condition that has plagued the waiting rooms of clinicians from family practitioners, urologists, to internists. This review seeks to focus on chronic pain in the genitourinary community and review techniques of pain management in the current intervention for orchialgia, as well as identify future methods of treatment.
*History of pain management
*Orchialgia and the clinician
*Initial evaluation
*Pathophysiology
*Initial therapy
Selective nerve block
Epididymectomy
Varicocelectomy
Orchiectomy
Microsurgical denervation of the spermatic cord
Post-vasectomy pain
*Other therapies
Multiphoton microscopy
Ultrasound-guided targeted cryoablation of the perispermatic cord
Pulsed radiofrequency
Onabotulinum toxin
Conclusions
Chronic orchialgia is a complex condition that will be encountered by most practicing clinicians. When should a surgeon operate for scrotal pain? The short answer is that one should operate only when one has to. The goal is to operate less and on better-selected patients with more focused procedures. Testicular pain treatment should follow a systematic protocol that may be escalated to surgery when conservative therapy fails. Referral to adjunct specialties such as a chronic pain specialist, psychiatrist, physical therapist, or general surgeon may also be indicated.
The management of pain is a complex condition that will be encountered by most practicing clinicians. In the genitourinary community, testicular pain may be classified as acute or chronic. Initial evaluation of chronic groin and scrotal content pain (CGSCP) begins with a detailed history and physical examination to elucidate the presenting pathology. Multiple therapy algorithms have been proposed with no definitive consensus; however, most begin with conservative intervention and medical management prior to advancing to more invasive procedures. Surgical approaches may range from reconstruction, as in vasovasostomy for post-vasectomy pain syndrome, to excision of the offending agent, as in epididymectomy. This review seeks to focus on chronic pain in the genitourinary community and review techniques of pain management in the current intervention for orchialgia, as well as identify future methods of treatment.
Introduction
Orchialgia is a condition that has plagued the waiting rooms of clinicians from family practitioners, urologists, to internists. This review seeks to focus on chronic pain in the genitourinary community and review techniques of pain management in the current intervention for orchialgia, as well as identify future methods of treatment.
*History of pain management
*Orchialgia and the clinician
*Initial evaluation
*Pathophysiology
*Initial therapy
Selective nerve block
Epididymectomy
Varicocelectomy
Orchiectomy
Microsurgical denervation of the spermatic cord
Post-vasectomy pain
*Other therapies
Multiphoton microscopy
Ultrasound-guided targeted cryoablation of the perispermatic cord
Pulsed radiofrequency
Onabotulinum toxin
Conclusions
Chronic orchialgia is a complex condition that will be encountered by most practicing clinicians. When should a surgeon operate for scrotal pain? The short answer is that one should operate only when one has to. The goal is to operate less and on better-selected patients with more focused procedures. Testicular pain treatment should follow a systematic protocol that may be escalated to surgery when conservative therapy fails. Referral to adjunct specialties such as a chronic pain specialist, psychiatrist, physical therapist, or general surgeon may also be indicated.
