Chronic testicular pain (orchalgia)...

Chronic testicular pain (orchalgia) is unilateral or bilateral scrotal pain lasting for more than three month and interfering with normal activities. Because of the innervation of the scrotum testicular pain may originate in the abdomen or testis. The cause of testicular pain may be difficult to determine. In approximately 25 percent of cases, an underlying cause for orchalgia cannot be identified. A review on Kapoor and Nargund stresses a systematic approach to the diagnosis of chronic testicular pain (see the accompanying figure).

The history should include questions concerning lower urinary tract and bowel symptoms, as well as a undivided genitourinary and sexual history. The attack and nature of the pain can give important guides to diagnosis. Intermittent testicular torsion is characterized by way of recurrent episodes of severe pain that may be accompanied from nausea and systemic symptoms. The pain may last from minutes to hours. Pain following groin or scrotal surgery is frequently continuous and exacerbated by sexual intercourse. Following vasectomy, pain may proceed from a sperm granuloma in the epididymis or from entrapment of energize fibers in granulation tissue. Chronic orchalgia is reported following about united per 1,000 vasectomies. Varicocele-related pain is characteristically described as a persistent, aching discomfort or heavy sensation that is relieved on lying down. Although testicular tumors are usually described as painless, up to 40 percent of patients report torpid aching or heaviness. Bleeding into a tumor or other abnormalities of the like kind as hydroceles, epididymal cysts, and spermatoceles can bring into view acute or severe pain. Testicular pain associated with chronic infection is usually associated with urinary symptoms or those of sexually transmitted diseases.

Physical examination should include the entire genital area. Testicular examination should be deportment ed in both standing and lying positions. Areas of hyperesthesia should be noted and a search made for herniae. Rectal examination is necessary to assess rectal and prostate areas. Additional investigations hang on the most likely diagnosis. Ultrasound can be diagnostic for anatomic lesions. Color Doppler ultrasonography is the best investigation for vascular lesions. Investigations of the upper urinary tract, like as intravenous urography and ultrasonography, may be appropriate for referr renal pain.

The management of testicular lesions hangs on the etiology. Patients should be cautioned that surgical treatment may not dissolve pain. For cases where the etiology cannot be determined, ilio-inguinal pluck block or microsurgical denervation may relieve the pain. Systemic analgesia or orchidectomy may be required in individual cases. In so extreme cases, psychologic consultation is make acceptableed to ensure that the pain is neurologic and not psychogenic in origin.

Kapoor s Nargund VH. Diagnosing testicular pain. Practitioner December 2002;246:792-800

COPYRIGHT 2003 American Academy of Family Physicians

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