Korean J Urol.  2015 Jan;56(1):3-11. 10.4111/kju.2015.56.1.3.

Scrotal pain: Evaluation and management

• Gordhan CG
• Sadeghi-Nejad H

• KMID: 2070263
• DOI: http://doi.org/10.4111/kju.2015.56.1.3

Abstract

Scrotal pain is a common complaint in a urological practice. Its diagnosis can prove challenging in both acute and chronic forms and requires a thorough and complete history and physical examination. This article discusses the evaluation and management of several entities of scrotal pain, including testicular torsion, epididymitis, postvasectomy pain, varicocele, and chronic orchialgia.

Keyword

Pain; Pain management; Physical examination, Scrotum

MeSH Terms

Diagnosis, Differential
Epididymitis/*diagnosis/drug therapy
Humans
Male
Pain/*diagnosis
*Pain Management
Pain, Postoperative
Physical Examination
*Scrotum
Spermatic Cord Torsion/*diagnosis/surgery
Testis/physiopathology
Varicocele/*diagnosis/physiopathology/therapy
Vasectomy

Reference

1. Marcozzi D, Suner S. The nontraumatic, acute scrotum. Emerg Med Clin North Am. 2001; 19:547–568.

2. Van Glabeke E, Khairouni A, Larroquet M, Audry G, Gruner M. Acute scrotal pain in children: results of 543 surgical explorations. Pediatr Surg Int. 1999; 15:353–357.

3. McAndrew HF, Pemberton R, Kikiros CS, Gollow I. The incidence and investigation of acute scrotal problems in children. Pediatr Surg Int. 2002; 18:435–437.

4. Hayden LJ. Chronic testicular pain. Aust Fam Physician. 1993; 22:1357–1359. 13621365

5. Ben-Sira L, Laor T. Severe scrotal pain in boys with Henoch-Schönlein purpura: incidence and sonography. Pediatr Radiol. 2000; 30:125–128.

6. Laor T, Atala A, Teele RL. Scrotal ultrasonography in Henoch-Schönlein purpura. Pediatr Radiol. 1992; 22:505–506.

7. Holland JM, Feldman JL, Gilbert HC. Phantom orchalgia. J Urol. 1994; 152(6 Pt 2):2291–2293.

8. Ringdahl E, Teague L. Testicular torsion. Am Fam Physician. 2006; 74:1739–1743.

9. Dogra V, Bhatt S. Acute painful scrotum. Radiol Clin North Am. 2004; 42:349–363.

10. Knight PJ, Vassy LE. The diagnosis and treatment of the acute scrotum in children and adolescents. Ann Surg. 1984; 200:664–673.

11. Gerber GS, Brendler CB. Evaluation of the urologic patient: history, physical examination, and urinalysis. In : Walsh PC, Retik AB, Vaughan ED, Wein AJ, Kavoussi LR, Novick AC, editors. Campbell's urology. 8th ed. Philadelphia: Saunders;2002. p. 83–110.

12. Rabinowitz R. The importance of the cremasteric reflex in acute scrotal swelling in children. J Urol. 1984; 132:89–90.

13. Herbener TE. Ultrasound in the assessment of the acute scrotum. J Clin Ultrasound. 1996; 24:405–421.

14. Burgher SW. Acute scrotal pain. Emerg Med Clin North Am. 1998; 16:781–809.

15. Boettcher M, Bergholz R, Krebs TF, Wenke K, Treszl A, Aronson DC, et al. Differentiation of epididymitis and appendix testis torsion by clinical and ultrasound signs in children. Urology. 2013; 82:899–904.

16. Trojian TH, Lishnak TS, Heiman D. Epididymitis and orchitis: an overview. Am Fam Physician. 2009; 79:583–587.

17. Centers for Disease Control and Prevention. 1998 Guidelines for treatment of sexually transmitted diseases. MMWR Morb Mortal Wkly Rep. 1998; 47(RR-01):1–118.

18. Joo JM, Yang SH, Kang TW, Jung JH, Kim SJ, Kim KJ. Acute epididymitis in children: the role of the urine test. Korean J Urol. 2013; 54:135–138.

19. Hori S, Tsutsumi Y. Histological differentiation between chlamydial and bacterial epididymitis: nondestructive and proliferative versus destructive and abscess forming: immunohistochemical and clinicopathological findings. Hum Pathol. 1995; 26:402–407.

20. Redshaw JD, Tran TL, Wallis MC, deVries CR. Epididymitis: a 21-year retrospective review of presentations to an outpatient urology clinic. J Urol. 2014; 192:1203–1207.

21. Santillanes G, Gausche-Hill M, Lewis RJ. Are antibiotics necessary for pediatric epididymitis? Pediatr Emerg Care. 2011; 27:174–178.

22. Hamdan M, Cerabona V. Epididymitis in infants. Apropos of a case and review of the literature. J Urol (Paris). 1991; 97:228–229.

23. Haecker FM, Hauri-Hohl A, von Schweinitz D. Acute epididymitis in children: a 4-year retrospective study. Eur J Pediatr Surg. 2005; 15:180–186.

24. Cicek T, Cicek Demir C, Coban G, Coner A. Amiodarone induced epididymitis: a case report. Iran Red Crescent Med J. 2014; 16:e13929.

25. Hutcheson J, Peters CA, Diamond DA. Amiodarone induced epididymitis in children. J Urol. 1998; 160:515–517.

26. Gomez Garcia I, Gomez Mampaso E, Burgos Revilla J, Molina MR, Sampietro Crespo A, Buitrago LA, et al. Tuberculous orchiepididymitis during 1978-2003 period: review of 34 cases and role of 16S rRNA amplification. Urology. 2010; 76:776–781.

27. Kavoussi PK, Costabile RA. Orchialgia and the chronic pelvic pain syndrome. World J Urol. 2013; 31:773–778.

28. Choe JM, Kirkemo AK. Questionnaire-based outcomes study of nononcological post-vasectomy complications. J Urol. 1996; 155:1284–1286.

29. Awsare NS, Krishnan J, Boustead GB, Hanbury DC, McNicholas TA. Complications of vasectomy. Ann R Coll Surg Engl. 2005; 87:406–410.

30. McMahon AJ, Buckley J, Taylor A, Lloyd SN, Deane RF, Kirk D. Chronic testicular pain following vasectomy. Br J Urol. 1992; 69:188–191.

31. West AF, Leung HY, Powell PH. Epididymectomy is an effective treatment for scrotal pain after vasectomy. BJU Int. 2000; 85:1097–1099.

32. Nangia AK, Myles JL, Thomas AJ JR. Vasectomy reversal for the post-vasectomy pain syndrome: a clinical and histological evaluation. J Urol. 2000; 164:1939–1942.

33. Cho SH, Min SK, Lee ST. Associations of ultrasonographic features with scrotal pain after vasectomy. Korean J Urol. 2011; 52:782–786.

34. Sweeney P, Tan J, Butler MR, McDermott TE, Grainger R, Thornhill JA. Epididymectomy in the management of intrascrotal disease: a critical reappraisal. Br J Urol. 1998; 81:753–755.

35. Paxton LD, Huss BK, Loughlin V, Mirakhur RK. Intra-vas deferens bupivacaine for prevention of acute pain and chronic discomfort after vasectomy. Br J Anaesth. 1995; 74:612–613.

36. Woolf CJ, Chong MS. Preemptive analgesia: treating postoperative pain by preventing the establishment of central sensitization. Anesth Analg. 1993; 77:362–379.

37. Bruning CO 3rd. Re: Vasectomy reversal for treatment of the post-vasectomy pain syndrome. J Urol. 1997; 158:1528.

38. Edwards IS. Vasectomy reversal for treatment of the postvasectomy pain syndrome. J Urol. 1997; 158:2252.

39. Myers SA, Mershon CE, Fuchs EF. Vasectomy reversal for treatment of the post-vasectomy pain syndrome. J Urol. 1997; 157:518–520.

40. Lee JY, Cho KS, Lee SH, Cho HJ, Cho JM, Oh CY, et al. A comparison of epididymectomy with vasectomy reversal for the surgical treatment of postvasectomy pain syndrome. Int Urol Nephrol. 2014; 46:531–537.

41. Meacham RB, Townsend RR, Rademacher D, Drose JA. The incidence of varicoceles in the general population when evaluated by physical examination, gray scale sonography and color Doppler sonography. J Urol. 1994; 151:1535–1538.

42. Saypol DC. The varicocele. J Androl. 1981; 2:61–71.

43. Lee HJ, Cheon SH, Ji YH, Moon KH, Kim KS, Park S, et al. Clinical characteristics and surgical outcomes in adolescents and adults with varicocele. Korean J Urol. 2011; 52:489–493.

44. Ahlberg NE, Bartley O, Chidekel N, Fritjofsson A. Phlebography in varicocele scroti. Acta Radiol Diagn (Stockh). 1966; 4:517–528.

45. Comhaire F, Kunnen M, Nahoum C. Radiological anatomy of the internal spermatic vein(s) in 200 retrograde venograms. Int J Androl. 1981; 4:379–387.

46. Coolsaet BL. The varicocele syndrome: venography determining the optimal level for surgical management. J Urol. 1980; 124:833–839.

47. Kohler FP. On the etiology of varicocele. J Urol. 1967; 97:741–742.

48. Kwak N, Siegel D. Imaging and interventional therapy for varicoceles. Curr Urol Rep. 2014; 15:399.

49. Agarwal A, Sharma RK, Desai NR, Prabakaran S, Tavares A, Sabanegh E. Role of oxidative stress in pathogenesis of varicocele and infertility. Urology. 2009; 73:461–469.

50. Peterson AC, Lance RS, Ruiz HE. Outcomes of varicocele ligation done for pain. J Urol. 1998; 159:1565–1567.

51. Pilatz A, Altinkilic B, Kohler E, Marconi M, Weidner W. Color Doppler ultrasound imaging in varicoceles: is the venous diameter sufficient for predicting clinical and subclinical varicocele? World J Urol. 2011; 29:645–650.

52. Chiou RK, Anderson JC, Wobig RK, Rosinsky DE, Matamoros A Jr, Chen WS, et al. Color Doppler ultrasound criteria to diagnose varicoceles: correlation of a new scoring system with physical examination. Urology. 1997; 50:953–956.

53. Cho KS, Seo JT. Effect of varicocelectomy on male infertility. Korean J Urol. 2014; 55:703–709.

54. Yaman O, Ozdiler E, Anafarta K, Gogus O. Effect of microsurgical subinguinal varicocele ligation to treat pain. Urology. 2000; 55:107–108.

55. Kim HT, Song PH, Moon KH. Microsurgical ligation for painful varicocele: effectiveness and predictors of pain resolution. Yonsei Med J. 2012; 53:145–150.

56. Davis BE, Noble MJ, Weigel JW, Foret JD, Mebust WK. Analysis and management of chronic testicular pain. J Urol. 1990; 143:936–939.

57. Levine L. Chronic orchialgia: evaluation and discussion of treatment options. Ther Adv Urol. 2010; 2:209–214.

58. Levine LA, Matkov TG. Microsurgical denervation of the spermatic cord as primary surgical treatment of chronic orchialgia. J Urol. 2001; 165(6 Pt 1):1927–1929.

59. Woolf CJ, Salter MW. Neuronal plasticity: increasing the gain in pain. Science. 2000; 288:1765–1769.

60. Sinclair AM, Miller B, Lee LK. Chronic orchialgia: consider gabapentin or nortriptyline before considering surgery. Int J Urol. 2007; 14:622–625.

61. Basal S, Ergin A, Yildirim I, Goktas S, Atim A, Sizlan A, et al. A novel treatment of chronic orchialgia. J Androl. 2012; 33:22–26.

62. Siu W, Ohl DA, Schuster TG. Long-term follow-up after epididymectomy for chronic epididymal pain. Urology. 2007; 70:333–335.

63. Werthman P. Vasectomy reversal for post-vasectomy pain syndrome: a ten-year experience. J Urol. 2010; 183:Suppl. e752.

64. Strom KH, Levine LA. Microsurgical denervation of the spermatic cord for chronic orchialgia: long-term results from a single center. J Urol. 2008; 180:949–953.

65. Cadeddu JA, Bishoff JT, Chan DY, Moore RG, Kavoussi LR, Jarrett TW. Laparoscopic testicular denervation for chronic orchalgia. J Urol. 1999; 162(3 Pt 1):733–735.

66. Larsen SM, Benson JS, Levine LA. Microdenervation of the spermatic cord for chronic scrotal content pain: single institution review analyzing success rate after prior attempts at surgical correction. J Urol. 2013; 189:554–558.