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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J. Jamnagerwalla and H.H. Kim
rhaphy groin pain, also known as inguinodynia . The incidence ranges
from 0 to 62.9 %, with up to 10 % of patients falling into the moderate to
severe pain group [ 74 ]. In a large population study of over 2400 patients
who underwent either inguinal or femoral hernia repair, the incidence of
groin pain significant enough to interfere with daily activity was as high
as 6 % [ 75 ]. Inguinodynia differs from hernia-related groin pain, as the
pain is new onset after the hernia repair and lasts longer than 3 months.
The pain may be secondary to a variety of factors, including nerve trauma
from retraction and dissection, neuroma formation after partial or
complete transection, or nerve entrapment either by suture material or
mesh associated fibrosis [ 74 ]. The pain can be classified as neuropathic
or non- neuropathic , with approximately 50 % of patients falling into
each category [ 76 ]. Neuropathic pain tends to be exercise induced with
radiation down into the scrotum, and can be relieved by stretching or
positioning techniques. Spermatic cord blocks can be diagnostic and
therapeutic with up to 80 % of men with neuropathic inguinodynia
reporting relief of their pain [ 76 ]. Non-neuropathic pain is secondary
to a variety of etiologies, including recurrent hernias, periostitis, and
spermatic cord congestion [ 76 ].
The treatment of inguinodynia begins with conservative treatment
including rest and NSAIDS, similar to the treatment of post-vasectomy
pain syndrome. In patients who have chronic, debilitating pain
despite conservative management, surgical intervention is indicated.
Surgical management is dependent on the underlying pathology of the
pain. 80–95 % of patients with neuropathic pain have relief from triple
neurectomy (ligation of the ilioinguinal, iliohypogastric, and genital
branch of the genitofemoral nerve) [ 77 ]. Removal of mesh is effective
for non-neuropathic pain secondary to spermatic cord compression from
local mesh fibrosis. A microsurgical spermatic cord neurolysis can be
performed concurrently if there is a significant component of associated
spermatic cord/testicular pain. Intraoperative guidelines to prevent
inguinodynia during routine hernia and further management are discussed
in Chap. 28 , “Prevention of Pain: Optimizing the Open Primary
Inguinal Hernia Repair Technique .”
Chronic Pelvic Pain Syndrome Although a majority of patients evaluated
for chronic groin pain have a diagnosable, identifiable source of pain, no
cause is identified in up to 25 % of cases [ 1 ]. Often these men are given the
nonspecific diagnosis of chronic epididymitis and/ or chronic prostatitis