Treatment of chronic testicular pain

Treatment of chronic testicular pain

As a best urologist in Palam, West Delhi, I have decided to write this post after having treated in my practice, in recent weeks, several patients who had this problem and had long been going around trying to solve without success. In general, the patients I see in the kidney hospital in Palam, West Delhi have been evaluated by a multitude of specialists, they have undergone all kinds of tests, they have undergone multiple treatments ... without solving chronic pain.

The first thing we should do with a patient who is consulting for chronic testicular pain is a good clinical history in which we value:

• Analysis of pain and its circumstances: from when you have it; possible causes (previous surgeries in the linguino-scrotal, abdominal or retroperitoneal area, traumatisms, infections or inflammations in these areas, etc.); characteristics and intensity of pain; irradiation thereof; triggering factors (when sitting, when urinating, when having an erection, when making a bowel movement, when the testicle is palpated, etc.); associated symptomatology (urinary frequency, urgency, nocturia, rectal or urinary tenesmus); etc.
• Physical examination:  of the testicle, epididymis, deferent, spermatic cord, inguinal canal (hernias), abdomen, fist, renal percussion, etc.
• Essential tests:  fractionated urine and semen culture, testicular eco-Doppler, abdominal and urological ultrasound. In some cases, it may be useful to perform Magnetic Nuclear Resonance of the pelvis.

With respect to treatment, our approach is as follows:

• First, treatment of any process that could have caused the pain: torsion of testicular appendix, varicocele, epididymitis, orchitis, inguinal hernia, testicular tumour, tension hydrocele, etc. One should not lose sight of the so-called referred pain, that is, when the pain is caused by problems in other abdominal viscera but the patient locates it in the testicle (for example, kidney or ureter stones, appendicitis, etc.).
• Second, use of analgesics. We use Paracetamol, Tramadol or the combination of both, depending on the intensity of the pain. In some cases, it is necessary to resort to specific treatments for what we call neuropathic pain (pain caused by disease or direct problem of the somatosensory nervous system). Among these neuropathic pain treatments, we have: carbamazepine, gabapentin, pregabalin, tricyclic antidepressants, etc.
• In many patients, especially if the pain is of moderate or severe intensity, very constant, long evolution, etc. it is advisable to resort to psychological or psychiatric support to avoid anxiety, depression, stress, etc. associated with this situation.
• If the pain does not remit with medication, we can resort to infiltration of the spermatic cord with anaesthetics and corticosteroids; radiofrequency; etc.

But in a high percentage of cases (possibly in more than 50% of patients) none of the above solves the problem. In these patients the only solution is surgery of denervation of the testicle. This is a technique that consists in sectioning all the nervous branches that collect the sensitivity of the testicle, thus avoiding the transmission of the painful sensation to the central nervous system. As a preliminary step, we should perform a cord block with local anaesthetics to confirm the possible efficacy of the subsequent surgical intervention. If the aesthetic block is effective, we will have a guarantee that the surgery will solve the pain. The surgical procedure must be performed by the best urologist in Janakpuri, West Delhi with the help of a surgical microscope that allows us to identify the arteries (testicular and deference); the veins; the lymphatics and the vas deferens, which will be the only structures that will be respected.