A study suggests that men suffering from refractory chronic scrotal content pain may benefit from a series of spermatic cord blocks, which is safe and minimally invasive. However, response to cord block series appears independent of symptom duration, perceived etiology, or prior medical and surgical treatments.
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What is Chronic Scrotal Content Pain or
CSCP ?
A chronic scrotal content pain is one of the more challenging
urological problems to manage. It is a frustrating health disorder to diagnose
and effectively treat for both the patient and doctors, as there is no
universally accepted treatment guidelines available.
Orchialgia
is the medical term for chronic scrotal content pain or chronic testicular
pain, which is defined as constant or intermittent pain in the testicles, which
lasts for 3 or more months and interfering with one’s quality of life or QoL. This
is not an uncommon problem for men of all ages; however, this condition is seen
more frequently in young male adults.
The pathogenesis is not clearly understood, and treatment
ultimately depends on the etiology of the problem. There were many patients with
this condition end up seeing medical professionals across many disciplines.
Chronic testicular pain or Chronic scrotal content
pain (CSCP) is defined by at least 3 months of chronic or intermittent scrotal
content pain with severity that interferes with one’s quality of life,
prompting the patient to seek medical treatment.
What Causes Chronic Scrotal Content Pain or
Chronic Testicular Pain?
Chronic Scrotal Content Pain (CSCP) or the chronic
testicular pain can be caused by numerous conditions, and it’s important to
rule out the following possibilities:
- Groin hernia: A prolapse of intra-abdominal contents through a weakness in the connective tissue support of the groin.
- Hydrocele: An excess fluid collection in the sac surrounding the testes.
- Idiopathic: This fancy medical term means that we are clueless about the origin of the pain. Unfortunately, many men have idiopathic orchialgia, a distressing and frustrating experience for both patient and urologist.
- Infection: An infection of the testes (orchitis), epididymis (epididymitis), both (epididymo-orchitis), or the spermatic cord (funiculitis). Infections can be bacterial, viral, and at times inflammatory without an actual infection.
- Pelvic floor muscle tension myalgia: Excessive muscle tension in these muscles can cause pelvic pain, including pain in the testes.
- Prior operations: Groin hernias are most commonly associated with chronic testes pain; less commonly, vasectomies and any other type of groin or pelvic surgery.
- Referred pain: Pain perceived in the testes, but originating elsewhere, e.g., a kidney stone that has dropped into the ureter, or a lower spine issue affecting the nerves to the testes.
- Spermatocele: A cyst resulting from a blockage of one of the sperm ducts within the epididymis.
- Tendonitis: There are numerous muscles with tendons that insert into the pubic bone region that can be subject to injury and inflammation.
- Torsion: A twist of the testes or one of the testes or epididymal appendages.
- Trauma: Injury.
- Tumor: A benign or malignant mass of the testes or epididymis.
- Varicocele: Varicose veins of the spermatic cord.
Assessment of the patient with chronic testicular pain
includes a detailed medical history and a careful examination of the scrotal
contents, groin, and prostate, if necessary. A urinalysis and urine culture
will also be taken. It’s also helpful to obtain an ultrasound of the scrotum, a
study which utilizes sound waves to image the testicle and epididymis. Occasionally,
it’s warranted to obtain imaging studies of the upper urinary tract and pelvis,
as well as a CT or MRI of the spine if there is back or hip pain.
Researchers assessed the relief of chronic scrotal
content pain following spermatic cord block series, with a combination of local
anesthetic and a steroid, and assessed factors correlated with a positive
response and complications through a retrospective chart review of patients who
underwent the procedure between 2012 and 2019.
Utilizing an 11-point numerical pain rating scale, researchers
compared pain scores before and after treatment. Experts also performed a
univariate analysis to evaluate the differences between responders and
non-responders, as well as rank-order correlation to evaluate the relationship
between symptom duration and response.
There were 44 men with chronic scrotal content pain
for a median duration of 24 months, who underwent a spermatic cord block
series, were included. Among the patients, 31 or 70.5% experienced sustained
relief, while 9 patients or 20.5% had complete pain resolution, at a median
follow-up of 16 months.
There were no differences noted in symptom duration,
perceived etiology, or previous treatments between responders and
non-responders. Also, there was no correlation seen between response and pain
duration. There were 5 men or 11.4% developed minor complications.
Researchers said that future studies should be
performed to evaluate long-term durability and predictors of success.
Source: J Urol 2021;206:725-732