Brian P. Jacob, David C. Chen, Bruce Ramshaw, Shirin Towfigh (eds.) - The SAGES Manual of Groin Pain-Springer International Publishing (2016)

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10. Groin Pain Etiology: Spermatic Cord and Testicular Causes 115 [ 3 ]. The prevalence of chronic epididymitis in men visiting urology clinics in Canada was estimated to be about 0.9 % [ 4 ]. In 2005, Strebel et al. found that urologists had an average of 6.5 new encounters for chronic scrotal pain per month, and 2.5 % of all urological visits led to a diagnosis of chronic scrotal pain syndrome [ 5 ]. The incidence of chronic scrotal pain was estimated to be about 350–450 per 100,000 men aged 25–85 years [ 5 ]. Multiple publications have reported the peak age of chronic pelvic pain in their cohort to be at ages 40–49, with range from 20 to 83 [ 6 – 10 ]; however, these numbers were based on trials of men seeking interventions for chronic pain, and not direct epidemiological measurements. Anatomy Testicular pain is mediated by scrotal and spermatic branches of the genitofemoral and ilioinguinal nerves, as well as by sympathetic fibers along the testicular artery [ 8 ]. The genital branch of the genitofemoral nerve supplies the cremaster muscle and scrotal skin, and a branch of the ilioinguinal nerve supplies the skin of the upper scrotum and base of the penis. There is significant sensory overlap among the ilioinguinal , iliohypogastric , and genitofemoral nerves [ 11 ]. The course of the nerves through the inguinal canal can be seen in Fig. 10.1 [ 12 ]. Spermatic cord traction during scrotal surgery may trigger peritoneal stimulation [ 13 ]. The superior and inferior spermatic nerves provide autonomic innervation [ 14 ]. The superior spermatic nerve originates from the celiac and aortic plexuses and descends along the testicular vessels and forms the major nerve supply of the testis [ 14 ]. Sympathetic fibers arise from the thoracic segments 10 and 11, whereas the parasympathetic fibers arise from the vagus nerve [ 14 ]. The inferior spermatic nerve travels with the ductus deferens and the epididymis to the lower pole of the testis [ 14 ]. Sympathetic fibers arise from the inferior mesenteric and hypogastric plexuses and parasympathetic fibers branch from the pelvic nerve [ 14 ]. Animal models indicate that the nerve supply to the testis helps to regulate its endocrine function, but the precise function of testicular innervation in humans remains unclear. Epididymal innervation consists of a high density of sympathetic nerve endings in the corpus and cauda of the epididymis, with progressive concentration approaching the ductus deferens, consistent with their contractile role during ejaculation [ 15 ].
116 J. Jamnagerwalla and H.H. Kim Quadratus lumborum m. Ilio hypogastric n. Ilio inguinal n. Genitalfemoral n. Sympathetic trunk Psoas m. Genital n. Lateral femoral cutanious n. Ilio hypogastric n. Femoral n. External spermatic n. Ilio inguinal n. Fig. 10.1. Pelvic nerves in relationship to the inguinal canal. Note the location of the genital branch of the genitofemoral nerve, ilioinguinal nerve, and iliohypogastric nerve as they travel through the inguinal ring (redrawn from Kapoor et al. [ 12 ] with kind permission of Medscape Reference from WebMD). Acute Groin Pain Although the focus of this chapter is spermatic cord and testicular causes of chronic groin pain, a review of acute groin pain highlights the range and complexity of pain in this region. Men with acute scrotal pain must be quickly triaged to identify those who need immediate surgical intervention, as a delayed diagnosis may result in significant morbidity and even mortality.
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Brian P. Jacob · David C. Chen Bru
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The SAGES Manual of Groin Pain Bria
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Foreword Inguinal hernia repair is
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Contents Part I Primary Groin Pain
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Contents ix 22 Management of Inguin
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Contents xi 45 Value-Based Clinical
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xiv Editors and Contributors Jeffre
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xvi Editors and Contributors David
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xviii Editors and Contributors Greg
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xx Editors and Contributors David S
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1. Introduction to Primary and Seco
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10 I.A. Gawlas and W.J. Peacock Ili
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12 I.A. Gawlas and W.J. Peacock Tra
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14 I.A. Gawlas and W.J. Peacock Var
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3. Complex Regional Pain Syndrome T
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4. Chief Complaint of Groin Pain: H
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4. Chief Complaint of Groin Pain…
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42 C. Ma and A. Ramaswamy inguinal
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44 C. Ma and A. Ramaswamy Categoriz
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46 C. Ma and A. Ramaswamy with no s
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48 C. Ma and A. Ramaswamy 26. Aasva
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50 I.M. Daoud and K. Dunn Other per
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52 I.M. Daoud and K. Dunn low herni
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54 I.M. Daoud and K. Dunn In the po
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56 I.M. Daoud and K. Dunn with a he
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58 I.M. Daoud and K. Dunn 13. O’C
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60 G.J. Mancini Occult Hernia Backg
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62 G.J. Mancini Magnetic resonance
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12. Chronic Pelvic Pain in Women 16
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174 J.M. Miller et al. Knowing the
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176 J.M. Miller et al. Fig. 13.2. A
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182 J.M. Miller et al. Fig. 13.9. C
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184 J.M. Miller et al. Fig. 13.14.
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192 J.M. Miller et al. Cardiac Cath
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194 B.J. Dunkin Noxious peripheral
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196 B.J. Dunkin Table 14.1. Summary
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198 B.J. Dunkin Rectus abdominis Ex
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200 B.J. Dunkin COX-1 COX-2 Celecpx
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202 B.J. Dunkin Table 14.2. Common
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204 B.J. Dunkin Possible Preoperati
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206 B.J. Dunkin Postoperative Pain
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208 B.J. Dunkin Summary Understandi
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15. Chronic Groin Pain Following An
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222 E.L. Felix not seem to alter th
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224 E.L. Felix nerves from the surg
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226 E.L. Felix Fig. 16.2. Lateral f
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228 E.L. Felix It has been establis
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230 E.L. Felix 18. Pollak R, Nyhus
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17. The Orthopedic Perspective on G
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246 J.F.M. Lange Jr. examination an
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248 J.F.M. Lange Jr. and remedial s
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250 J.F.M. Lange Jr. Best available
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252 J.F.M. Lange Jr. Neuropathic pa
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254 J.F.M. Lange Jr. This algorithm
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19. Radiologic Evaluation for Posto
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19 Radiologic Evaluation for Postop
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268 A. Malhotra extended variant of
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270 A. Malhotra steroid injections,
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272 A. Malhotra located just below
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274 A. Malhotra Nociceptive Acute N
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276 A. Malhotra 20. Rozen D, Parvez
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278 R. Álvarez intentionally or in
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Fig. 21.1. Material: A ballpoint pe
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Fig. 21.5. Dermatome mapping compat
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Fig. 21.9. Dermatome mapping compat
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286 R. Álvarez Subsequently, we mu
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288 R. Álvarez G : Granuloma H : H
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290 R. Álvarez Fig. 21.14. Same pa
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292 R. Álvarez 6. Lermite E, Arnau
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294 K.A. Seymour and J.S. Yoo Table
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296 K.A. Seymour and J.S. Yoo repro
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298 K.A. Seymour and J.S. Yoo Recur
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23. Mesh Removal for Chronic Pain:
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23. Mesh Removal for Chronic Pain
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320 I.T. MacQueen et al. inguinodyn
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322 I.T. MacQueen et al. Fig. 24.2.
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324 I.T. MacQueen et al. Timing and
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326 I.T. MacQueen et al. Fig. 24.4.
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328 I.T. MacQueen et al. Posthernio
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330 I.T. MacQueen et al. never be e
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25. Laparoscopic Triple Neurectomy
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26. Chronic Orchialgia: Workup and
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27. The Role of Bioactive Prostheti
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376 G. Campanelli et al. affecting
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378 G. Campanelli et al. into the w
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380 G. Campanelli et al. chronic gr
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382 G. Campanelli et al. A prospect
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384 G. Campanelli et al. open mesh
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386 G. Campanelli et al. 38. Alfier
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29. Prevention of Pain: Optimizing
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30. Prophylactic Neurectomy Versus
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Table 31.1. Selective neurectomy wi
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408 W.M.J. Reinpold and A.D. Schroe
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32. Chronic Groin Pain: Mesh or No
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Part IV Case Reports and Patients
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430 S. Towfigh were irregular and s
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432 S. Towfigh in addressing her sy
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434 S. Towfigh Conclusion We have y
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436 K.W. Kercher Physical Examinati
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438 K.W. Kercher Fig. 34.4. Left ad
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440 K.W. Kercher Fig. 34.5. After d
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442 K.W. Kercher the posterior wall
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444 K.W. Kercher Table 34.2. Surgic
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35. Chronic Post-inguinal Herniorrh
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35 Chronic Post-inguinal Herniorrha
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35 Chronic Post-inguinal Herniorrha
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36. Sports Hernia with Adductor Ten
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464 C.G. DuCoin and G.R. Jacobsen P
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466 C.G. DuCoin and G.R. Jacobsen O
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468 J.A. Blatnik and A.S. Prabhu a
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470 J.A. Blatnik and A.S. Prabhu Fi
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472 J.A. Blatnik and A.S. Prabhu ma
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474 S. Towfigh Physical Exam The pa
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476 S. Towfigh The patient’s loca
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478 S. Towfigh Fig. 39.2. Diagram o
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480 S. Towfigh periphery. He is 2+
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482 S. Towfigh References 1. Matthi
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484 N.A. Al-Enazi and B.P. Jacob
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486 N.A. Al-Enazi and B.P. Jacob Fi
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488 N.A. Al-Enazi and B.P. Jacob pu
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42. Patient with Chronic Pelvic Pai
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42. Patient with Chronic Pelvic Pai
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43. Thoracolumbar Syndrome James A.
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43. Thoracolumbar Syndrome 497 The
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43. Thoracolumbar Syndrome 499 Groi
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44. Patient with Referred Hip Pain
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44. Patient with Referred Hip Pain
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45. Value-Based Clinical Quality Im
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46. Patient Care Manager Perspectiv
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47. Workers’ Compensation: An Occ
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532 Index Athletic pubalgia (cont.)
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534 Index Chronic post-herniorrhaph
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536 Index Groin pain (cont.) magnet
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538 Index Ilioinguinal nerve (IIN)
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540 Index Local anesthetics (cont.)
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542 Index Peripheral nerve entrapme
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544 Index S Sacroiliac (SI) joint d
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546 Index Transperineal pudendal ne
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Brian P. Jacob, David C. Chen, Bruce Ramshaw, Shirin Towfigh (eds.) - The SAGES Manual of Groin Pain-Springer International Publishing (2016)

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