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

10. Groin Pain Etiology: Spermatic Cord and Testicular Causes
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study, with a specificity of 98 % and sensitivity of 95 % [ 37 ]. Spontaneous
passage rates of stones are directly related to size: as high as 60 % for
5–7 mm stones and less than 25 % for stones larger than 9 mm [ 38 ].
If surgical intervention is indicated, ureteroscopy with laser lithotripsy
results in a stone-free rate up to 96 % [ 39 ].
Chronic Groin Pain
Chronic pain, whether epididymal or testicular in origin, has been
defined as symptoms of at least 3 months’ duration [ 1 , 40 ]. Chronic pain
may be of neuropathic origin. When a nerve is sensitized by repeated
stimulation, pain can persist even after the initial insult has resolved.
This “hard-wiring” is mediated by peripheral and central modulation
that reduces the threshold for activation of the action potential and
decreases response latency [ 11 ]. Reversible causes of chronic groin pain
must be ruled out before diagnosing CPPS.
Testicular Mass Testicular cancer is the most common cancer among
men between ages 15 and 35 years—an age group that overlaps with that
of chronic groin pain [ 41 ]. Although the majority present with a painless
palpable testicular mass, some report a dull ache or heaviness in the
scrotum or lower abdomen. Approximately 10 % of men with testicular
cancer present with groin pain [ 42 ]. Ultrasound confirms the diagnosis,
after which tumor markers are sent prior to prompt inguinal orchiectomy.
Conversely, an incidental impalpable testicular mass may be diagnosed
during an evaluation for chronic groin pain. With increasingly
finer resolution of ultrasound, masses as small as 1 mm can be detected
long before they would be palpable [ 43 ]. Among men undergoing scrotal
ultrasound for reasons other than for the evaluation of a retroperitoneal
mass, Powell and Tarter found the incidence of testicular mass to be
0.38 % [ 44 ]. In men undergoing testicular ultrasound for infertility, the
incidence of testicular tumors was 0.5 % [ 45 ]. Generally, the treatment
of any sized testicular mass is radical orchiectomy, but some centers now
perform excisional biopsies of small masses under 1 cm in diameter with
the aid of an operating microscope, intraoperative ultrasound, and frozen
section pathologic analysis. In one review, 19 of 49 cases of incidental
testicular masses were found to be malignant [ 46 ].