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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epididymitis report being pain free after surgery, 22 % have persistent
but improved pain, and 25 % have no improvement. Efficacy rates for
epididymectomy performed for PVPS are similar, with 53 % being pain
free postoperatively [ 98 ]. Those with a primary complaint of epididymal
pain or discomfort related to a spermatocele or epididymal cyst had better
outcomes. One series reported 75 % were pain free after epididymectomy
and only 4 % reported no improvement [ 99 ]. Epididymectomy is
also effective for PVPS with epididymal obstruction or sperm granuloma
formation. West et al. found 90 % had long-term relief of scrotal
pain [ 100 ]. Given the association of chronic epididymitis and groin pain
with CPPS, it is not surprising that many fail to respond to epididymectomy.
Careful patient selection and counseling are critical; with the
exception of findings of epididymal masses or PVPS, other interventions
may be more appropriate.
Orchiectomy Orchiectomy should only be considered as a last option
among men with intractable pain. There is little data on out comes as
orchiectomy appropriately is not often performed for pain. Orchiectomy
for referred pain is unlikely to be successful, and careful patient selection
and counseling are critical.
An inguinal surgical approach is preferred. Davis et al. reported
superior results compared to the scrotal approach (73 % vs. 55 % complete
relief of pain) [ 1 ]. Unfortunately, up to 80 % have persistent pain
following orchiectomy [ 101 ]. The benefit of inguinal orchiectomy likely
involves high ligation of the spermatic cord, with resultant denervation
and release of nerve entrapment.
Conclusion
There are many urological causes of groin pain, and it is useful to
triage groin pain into acute and chronic causes. Urological chronic groin
pain has many reversible, treatable causes such as infection, hydrocele,
varicocele, or PVPS; however, a significant number of men do not have
an obvious etiology and fall under the CPPS domain. A multidisciplinary
approach should be used for those without a clear etiology of
groin pain, and operative management should be considered only after
failure of more conservative multimodal therapies.