Chronic Testicular Pain
Testicular pain is a problem that affects many men at some point in their lives. In milder cases, the pain is tolerable and goes away on its own, but on other occasions, it can be more severe and difficult to manage. Testicular pain can have many different causes, most of which are easily treatable.
Causes of Testicular pain
- Testicular torsion (twisting of the testicle’s blood supply)
- Prior scrotal/testicular surgery
- Problem with the epididymis: epididymitis (infection), cyst
- Post-vasectomy pain
- Pelvic floor dysfunction
- Neurologic disease
- Idiopathic (unknown cause)
Diagnosis of Testicular Pain
If you are presenting with testicular pain, your urologist will perform an examination of your testicles and take a complete history of your symptoms. He or she will likely perform a scrotal ultrasound and might recommend urine/blood testing. Some kinds of testicular pain are localized to the testicle or epididymis, while others stem from the brain and nervous system. To identify the source, your doctor may perform a cord block, which is an injection of a steroid and anesthetic into the area of the nerve supply to the testis (the spermatic cord). If a cord block provides temporary relief, this suggests that the pain originates in the testicle rather than from the brain and can be treated with surgery.
Treatment of Testicular Pain
- Testicular torsion – patients with this condition will need emergency surgery. A prolonged delay could cause the death of the testicle.
- Infection – antibiotics and possibly anti-inflammatory medications
- Trauma – either allowing it to heal on its own or surgery to fix a ruptured testicle
- Problem with the epididymis: epididymitis can be treated with antibiotics and sometimes requires prolonged or multiple courses. Epididymal cysts that cause pain can be removed surgically through a procedure called spermatocelectomy
- Post-vasectomy pain – medication to manage the pain or surgery to remove the nerves in the spermatic cord or reverse the vasectomy
- Pelvic floor dysfunction – stress reduction techniques or pelvic floor physical therapy
- Neurologic disease – treatment of the underlying neurologic condition
In some patients, medications or other interventions are not effective. Surgery with a microsurgical denervation of the spermatic cord may be recommended.
Microsurgical Denervation of the Spermatic Cord
Microsurgical denervation of the spermatic cord is an outpatient surgical procedure done through a small incision in the groin. The spermatic cord contains the arteries, veins, nerves, vas deferens, and lymphatic vessels that go to the testicle. During surgery, we use an operating microscope to identify all of these structures and cut all of them except the testicular arteries, lymphatics, and vas deferens. If a man no longer wants children, a vasectomy can be performed at the time of cord denervation. The procedure typically takes one to two hours, and the patient goes home the same day.
Over 90 percent of patients that undergo surgery have 70-100% resolution of their pain. Our financial coordinator can help patients determine whether they have insurance coverage for the surgery. Most insurance providers cover this procedure.
A spermatocele is a cyst in the epididymis that contains sperm. These cysts are often small and asymptomatic, but sometimes they can grow very large and cause pain. A spermatocelectomy is a surgery to remove the cyst as a way to treat the pain. The surgery is performed as a minor day surgery under general anesthesia and takes approximately 1 hour. A small incision is made in the middle of the scrotum and the cyst is carefully dissected off the epididymis while preserving the surrounding structures. The incision in the scrotum is closed with dissolvable sutures. In most instances, the pain caused by the spermatocele will fully resolve after surgery.