Chronic scrotal pain: Pathogenesis, clinical phenotypes and modern treatment concept (clinical lecture)
https://doi.org/10.29413/ABS.2022-7.4.4
Abstract
Chronic scrotal pain (CSP) is a general term, which defines variety of problems causing discomfort or pain in the scrotum, which can be caused by the problems with testicles and other structures of the scrotum: epididymis, vas deferens, paratesticular structures. For a practicing urologist, the diagnosis and treatment of chronic scrotal pain is always a difficult task due to the many reasons for its appearance and the variety of clinical symptoms. CSP is a widespread but poorly understood condition, the etiology of which often can not be identified. Pain localized in the scrotum makes up 38.8 % of all cases of chronic men’s pelvic pain. From 2.5 to 4.8 % of all visits to the urologist relate to CSP syndrome. Primary scrotal pain syndrome is not associated with infection or other local pathological processes that could cause pain. The treatment of chronic scrotal pain is challenging because the pain often does not react to the traditional treatments.
The purpose of this lecture is to draw the attention of urologists, general practitioners, and everyone who is interested in the problem of treating chronic scrotal pain to the possibilities of modern medicine in solving this multidisciplinary problem.
About the Author
K. B. Lelyavin
Irkutsk State Medical Academy of Postgraduate Education – Branch Campus of the Russian Medical Academy of Continuing Professional Education
Russian Federation
Russian Federation
Kirill B. Lelyavin – Dr. Sc. (Med.), Associate Professor at the Department of Emergency Medicine
Yubileyniy 100, Irkutsk 664049
References
1. Campbell K, Lipshultz L. Current trends and therapies in orchialgia management. Ther Adv Urol. 2021; 13: 17562872211026433. doi: 10.1177/17562872211026433
2. Guidelines of European Association of Urology (EAU), 2021. Presented at the 36th Annual Congress EAU. 2021. URL: http://uroweb.org/guidelines/compilations-of-all-guidelines [date of access: 06.04.2022].
3. Cirocchi R, Henry BM, Mercurio I, Tomaszewski KA, Palumbo P, Stabile A, et al. Is it possible to identify the inguinal nerves during hernioplasty? A systematic review of the literature and meta-analysis of cadaveric and surgical studies. Hernia. 2019; 23(3): 569-581. doi: 10.1007/s10029-018-1857-2
4. Ayyaz Ul Haq M, Rashid M, Gilchrist IC, Bertrand O, Kwok CS, Wong CW, et al. Incidence and clinical course of limb dysfunction post cardiac catheterization – a systematic review. Circ J. 2018; 82(11): 2736-2744. doi: 10.1253/circj. CJ-18-0389
5. Shoskes DA, Calixte N, Tadros N, Li J, Parekattil S. Validation of the chronic orchialgia symptom index for men with chronic orchialgia/chronic scrotal contents pain. Urology. 2018; 119: 39-43. doi: 10.1016/j.urology.2018.05.030
6. Polackwich AS, Arora HC, Li J, Levine L, Tojuola B, Parekattil S, et al. Development of a clinically relevant symptom index to assess patients with chronic orchialgia/chronic scrotal content pain. Transl Androl Urol. 2018; 7(2): S163-S168. doi: 10.21037/tau.2018.04.10
7. Strebel RT, Leippold T, Luginbuehl T, Muentener M, Praz V, Hauri D. Chronic scrotal pain syndrome: Management among urologists in Switzerland. Eur Urol. 2005; 47: 812-816. doi: 10.1016/j.eururo.2005.01.003
8. Christiansen CG, Sandlow JI. Testicular pain following vasectomy: A review of postvasectomy pain syndrome. J Androl. 2003; 24(3): 293-298. doi: 10.1002/j.1939-4640.2003.tb02675.x
9. Quallich SA, Arslanian-Engoren C. Chronic testicular pain in adult men: An integrative literature review. Am J Mens Health. 2013; 7(5): 402-413. doi: 10.1177/1557988313476732
10. Aljumaily A, Al-Khazraji H, Gordon A, Lau S, Jarvi KA. Characteristics and etiologies of chronic scrotal pain: A common but poorly understood condition. Pain Res Manag. 2017; 2017: 3829168. doi: 10.1155/2017/3829168
11. Institute of Medicine (US) Committee on Advancing Pain Research, Care, and Education. Relieving pain in America: A blueprint for transforming prevention, care, education, and research. Washington (DC): National Academies Press (US); 2011.
12. Parekattil SJ, Ergun O, Gudeloglu A. Management of chronic orchialgia: Challenges and solutions – the current standard of care. Res Rep Urol. 2020; 12: 199-210. doi: 10.2147/RRU.S198785
13. Mathias SD, Kuppermann M, Liberman RF, Lipschutz RC, Steege JF. Chronic pelvic pain: prevalence, health-related quality of life, and economic correlates. Obstet Gynecol. 1996; 87(3): 321327. doi: 10.1016/0029-7844(95)00458-0
14. Hedelin H, Johannisson H, Welin L. Prevalence of the chronic prostatitis/chronic pelvic pain syndrome among 40-69-year-old men residing in a temperate climate. Scand J Urol. 2013; 47(5): 390-392. doi: 10.3109/00365599.2012.756930
15. Zermann DH, Ishigooka M, Doggweiler R, Schmidt RA. Neurourological insights into the etiology of genitourinary pain in men. J Urol. 1999; 161(3): 903-908.
16. Leslie SW, Sajjad H, Siref LE. Chronic testicular pain and orchalgia [Updated 2021 Sep 17]. Treasure Island (FL): StatPearls Publishing; 2022.
17. Ciftci H, Savas M, Yeni E, Verit A, Topal U. Chronic orchialgia and associated diseases. Current Urology. 2010; 4(2): 67-70. doi: 10.1159/000253415
18. Korneyev IA. Non-inflammatory chronic pelvic pain syndrome (scrotal pain) in an infertile man with non-palpable testicular seminoma and bilateral testicular microlithiasis. Case study. Urology Herald. 2019; 7(3): 55-58. (In Russ.) doi: 10.21886/2308-6424-20197-3-55-58
19. Luo L, Wu SZ, Zhu C, Fan Q, Liu K, Sun G. Psychological long-term effects of sterilization on anxiety and depression. Contraception. 1996; 54(6): 345-357. doi: 10.1016/s0010-7824(96)00200-4
20. Kucher AN. Neurogenic inflammation: biochemical markers, genetic control and diseases. Bulletin of Siberian Medicine. 2020; 19(2): 171-181. (In Russ.). doi: 10.20538/1682-0363-2020-2-171-181
21. Singh V, Sinha RJ. Idiopathic chronic orchialgia – a frustrating issue for the clinician and the patient. Indian J Surg. 2008; 70(3): 107-110. doi: 10.1007/s12262-008-0032-x
22. Nassenstein C, Krasteva-Christ G, Renz H. New aspects of neuroinflammation and neuroimmune crosstalk in the airways. J Allergy Clin Immunol. 2018; 142(5): 1415-1422. doi: 10.1016/j.jaci.2018.09.011
23. Gupta P, Sil S, Ghosh R, Ghosh A, Ghosh T. Intracerebroventricular Aβ-induced neuroinflammation alters peripheral immune responses in rats. J Mol Neurosci. 2018; 66(4): 572-586. doi: 10.1007/s12031-018-1189-9
24. Petrova ES, Kolos EA. Current views on perineural cells: Unique origin, structure, functions. Journal of Evolutionary Biochemistry and Physiology. 2022; 58(1): 3-23. (In Russ.). doi: 10.31857/S0044452922010053
25. Ziegelmann MJ, Farrell MR, Levine LA. Evaluation and management of chronic scrotal content pain – a common yet poorly understood condition. Rev Urol. 2019; 21(2-3): 74-84.
26. Woolf CJ. Central sensitization: implications for the diagnosis and treatment of pain. Pain. 2011; 152(3): S2-S15. doi: 10.1016/j.pain.2010.09.030
27. Downie WW, Leatham PA, Rhind VM, Wright V, Branco JA, Anderson JA. Studies with pain rating scales. Ann Rheum Dis. 1978; 37(4): 378-381. doi: 10.1136/ard.37.4.378
28. National Institutes of Health. Warren Grant Magnuson Clinical Center. Pain intensity instruments. URL: https://acne.gr/wp-content/uploads/2016/06/PainNumericRatingScale.pdf [access date: 06.04.2022].
29. The Faces Pain Scale – revised. URL: iasp-pain.org/resources/faces-pain-scale-revised/ [date of access: 06.04.2022].
30. Strebel RT, Schmidt C, Beatrice J, Sulser T. Chronic scrotal pain syndrome (CSPS): The widespread use of antibiotics is not justified. Andrology. 2013; 1(1): 155-159. doi: 10.1111/j.20472927.2012.00017.x
31. Sansone RA, Sansone LA. Pain, pain, go away: Antidepressants and pain management. Psychiatry (Edgmont). 2008; 5(12): 16-19.
32. Calixte N, Brahmbhatt J, Parekattil S. Chronic testicular and groin pain: Pathway to relief. Curr Urol Rep. 2017; 18(10): 83. doi: 10.1007/s11934-017-0722-7
33. Dockray J, Aljumaily A, Lau S, Jarvi KA, Randomized A. Double-blind, controlled trial shows that onabotulinum toxin a nerve blocks do not provide improved pain control in men with chronic scrotal pain. J Urol. 2020; 203(4): 767-772. doi: 10.1097/JU.0000000000000658
34. Cui T, Terlecki R. Prevalence of relative deficiencies in testosterone and vitamin B12 among patients referred for chronic orchialgia: Implications for management. Am J Mens Health. 2018; 12(3): 608-611. doi: 10.1177/1557988316642723
35. Starke NR, Costabile RA. Medical management of chronic orchialgia. Transl Androl Urol. 2017; 6(1): S48-S50. doi: 10.21037/tau.2017.05.18
36. Parekattil SJ, Gudeloglu A, Brahmbhatt JV, Priola KB, Vieweg J, Allan RW. Trifecta nerve complex: Potential anatomical basis for microsurgical denervation of the spermatic cord for chronic orchialgia. J Urol. 2013; 190(1): 265-270. doi: 10.1016/j.juro.2013.01.045
37. Panunzio A, Tafuri A, Mazzucato G, Cerrato C, Orlando R, Pagliarulo V, et al. Botulinum toxin-a injection in chronic pelvic pain syndrome treatment: A systematic review and pooled meta-analysis. Toxins (Basel). 2022; 14(1): 25. doi: 10.3390/toxins14010025
38. Murthy PB, Parekh NV, Vij SC, Shoskes DA. Microscopic spermatic cord denervation for chronic orchialgia/chronic scrotal content pain: Operative outcomes and predictors of failure. Transl Androl Urol. 2020; 9(5): 1931-1936. doi: 10.21037/tau-20-561
39. Tan WP, Levine LA. Micro-denervation of the spermatic cord for post-vasectomy pain management. Sex Med Rev. 2018; 6(2): 328-334. doi: 10.1016/j.sxmr.2017.06.002
40. Calixte N, Kartal IG, Tojuola B, Gudeloglu A, Etafy M, Brahmbhatt JV, et al. Salvage ultrasound-guided targeted cryoablation of the perispermatic cord for persistent chronic scrotal content pain after microsurgical denervation of the spermatic cord. Urology. 2019; 130: 181-185. doi: 10.1016/j.urology.2019.04.027
41. Calixte N, Tojuola B, Kartal I, Gudeloglu A, Hirsch M, Etafy M, et al. Targeted robotic assisted microsurgical denervation of the spermatic cord for the treatment of chronic orchialgia or groin pain: A single center, large series review. J Urol. 2018; 199(4): 1015-1022. doi: 10.1016/j.juro.2017.10.030
42. Siu W, Ohl DA, Schuster TG. Long-term follow-up after epididymectomy for chronic epididymal pain. Urology. 2007; 70(2): 333-335. doi: 10.1016/j.urology.2007.03.080
43. Cadeddu JA, Bishoff JT, Chan DY, Moore RG, Kavoussi LR, Jarrett TW. Laparoscopic testicular denervation for chronic orchalgia. J Urol. 1999; 162(3 Pt 1): 733-735. doi: 10.1097/00005392199909010-00028
44. Sharlip ID, Belker AM, Honig S, Labrecque M, Marmar JL, Ross LS, et al. Vasectomy: AUA guideline. J Urol. 2012; 188(6): 24822491. doi: 10.1016/j.juro.2012.09.080
45. Smith-Harrison LI, Smith RP. Vasectomy reversal for postvasectomy pain syndrome. Transl Androl Urol. 2017; 6(1): S10-S13. doi: 10.21037/tau.2017.04.37
Review
For citations:
Lelyavin K.B. Chronic scrotal pain: Pathogenesis, clinical phenotypes and modern treatment concept (clinical lecture). Acta Biomedica Scientifica. 2022;7(4):34-44. (In Russ.) https://doi.org/10.29413/ABS.2022-7.4.4
Views:
1686
.png)
Email this article 
