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

26. Chronic Orchialgia:
Workup and Management
Jamin V. Brahmbhatt , Ahmet Gudeloglu ,
and Sijo J. Parekattil
Introduction
Chronic groin or scrotal content (inguinal canal, spermatic cord, testicular,
scrotum) pain ( CGSCP ) is a common presenting problem for
several specialists—emergency room, primary care, general surgeon,
and urologists. It can be both acute and chronic in nature and can be
managed with medical or surgical interventions. The pain can be unilateral
or bilateral and intermittent or constant and lasts longer than 3
months [ 1 , 2 ]. The pain can be idiopathic or caused by nerve irritation
or hypersensitivity through vasectomy, hernia repair, sports injury,
abdominal surgery, or any intervention that can irritate the genitofemoral
or ilioinguinal nerves. Although the exact mechanism for CGSCP is not
well understood, one common theme is a two-hit theory. There is a baseline
inflammatory or genetic process that leads to Wallerian degeneration
of the peripheral nerves . In the groin or scrotum this degeneration
may cause hypersensitivty of the ilioinguinal and genitofemoral nerves.
A second inciting event—trauma, surgery, or irritation of these nerves—
then leads to chronic neuropathic pain in this area (Fig. 26.1 ) [ 3 ].
CGSCP may affect over 100,000 men annually [ 4 , 5 ]. Prevalence can
range up to 33 % of men after vasectomy [ 6 ] and 63 % after inguinal
hernia repair [ 7 – 9 ]. After hernia repair, the pain can be neuropathic or
non-neuropathic secondary to mesh. Even with such a high prevalence
after hernia repair, only 1 % of patients who suffer from CGSCP may be
referred for further evaluation [ 10 ]. In this chapter we will review the
current literature and present a structured algorithm for the evaluation
and management of CGSCP.
© Springer International Publishing Switzerland 2016
B.P. Jacob et al. (eds.), The SAGES Manual of Groin Pain,
DOI 10.1007/978-3-319-21587-7_26
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