Friday, July 19, 2013

Chronic Testicular Pain

Chronic testicular pain is a very common condition.  It can be caused by a variety of disorders.  Interestingly, not all testicular pain is caused by disease or maladies within the testicles themselves.  Often, back or disk problems can cause testis pain as can pelvic inflammatory disorders, among others.  Sometimes, the testicular pain is part of a systemic chronic pain pathway disorder--an aberation of the pain pathway system itself.  The job of the urologist is to rule in and rule out certain causes for the testis pain and then treat the condition appropriately, ie with surgery when indicated, antibiotics when needed, and with nociceptive (pain-nerve fiber) directed treatments when warranted.

My algorythm goes something like this:

  • History and Physical Exam
  • Urine testing
  • Scrotal imaging when indicated 
  • Antibiotics for infectious conditions only
  • Nociceptive pain therapy, ie tricyclic therapy, anti-neuroleptics
  • Surgery: Microsurgical nerve dennervation
Using the above approach, the majority of patients can find adequate relief in a timely fashion.