Surgery is to be avoided if possible. Even if infection has not been identified a small number of patients may respond to a combination of antibiotics and non-steroidal anti-inflammatory drugs. Tricyclic antidepressants, such as imipramine, sometimes relieve the pain. Those with intractable symptoms may benefit from a multidisciplinary team approach involving a urologist and a pain clinic specialist including a psychologist. Transcutaneous electrical stimulation or TENS analgesia often have favorable results. This works on the principle that transcutaneous electrical stimulation causes release of endorphins in the nerves of the spinal cord that supply the scrotum.
A spermatic cord block with a local anesthetic such as xylocaine can be done in the doctor’s office. The procedure, if successful, can be repeated in regular intervals.
For patients who fail to respond to conservative management and wish to avoid the surgical options that are available in treating chronic orchialgia, a trial with an alpha blocker might be an option.
For patients in whom all medical treatments have failed and testicular pain continues to impair their quality of life, surgical intervention may be indicated as a last resort. A number of surgical strategies have been described.
Microsurgical denervation of the spermatic cord may provide relief of chronic testicular pain. Another technique is to divide the ilioinguinal nerve and its branches.
Removal of the epididmymis or epididymectomy should be performed only if the patient had been counselled regarding the likelihood of poor results.
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