About Testicular Pain / Cord Block
Chronic scrotal content pain is a vexing problem with no easy solution. Unfortunately, it is far more common than most people think, but physicians who specialize in this condition are few and far between. Sometimes men will have been through several doctors, multiple rounds of antibiotics, and still not have an effective solution. In the worst case, men with chronic scrotal pain can become marginalized by the health care system as narcotic abusers and psychiatric cases. Since clinicians at UPNT do not prescribe narcotics for this condition, this is not even an issue. We firmly believe, however, that men with chronic testicular pain have every reason to be depressed and have psychological issues. We therefore treat men with the compassion and discretion necessary to find the best treatment options, including a surgical solution. When a man presents with chronic, incurable testicular pain, our clinicians will perform a full evaluation to come up with medical, physical therapy or surgical options for this debilitating condition.
~45 min
For each spermatic cord during the Microsurgical Spermatic Cord Denervation (MSCD) procedure, a treatment for testicular pain
75%
Success rate of the MSCD procedure granting permanent pain relief
Signs and Symptoms of Testicular Pain
In most cases of chronic scrotal pain, there is an inciting event. Most often this is epididymitis – and inflammatory / infectious condition affecting the epididymis – a small organ sitting on top of the testis, shaped like an 80’s mullet, and the site of sperm maturation. When this gets inflamed with refluxing urine, or infected with bacteria, it becomes swollen and extremely painful. Most of the time, the pain is bad enough that men will seek care and are usually treated with a combination of antibiotics and ant-inflammatory medications, usually with a scrotal ultrasound for good measure to confirm the diagnosis.
In theory, once this acute process is over, things should return to baseline and be normal. Unfortunately, this is not the case for everyone. Sometimes, the nerves that innervate that testis will upregulate their nociceptive (pain-sensing) properties, such that the testis remains painful even after the initial insult is gone. This may happen after the first bout of inflammation or may be the result of repeated inflammatory cycles or trauma. The nerves leading to the testis can undergo a process called Wallerian Degeneration where the nerve ends become abnormal and send increased signals of chronic pain. Separately, the pain can sometimes be due to nerve impingement from anywhere up the nerve chain – perhaps in the groin after a hernia repair, or even in the lower back due to spinal stenosis or a herniated disk.
Epididymitis
Painful inflammatory/infectious condition affecting the epididymis, a small organ on top of the testis
Wallerian degeneration
Nerve ends become abnormal and send increased signals of chronic pain even after the initial swelling is gone
Treatment Options for Testicular Pain
Testicular pain often leaves men in a debilitated state, stuck in a cycle of on-again, off-again pain. Many doctors do not know how to treat this condition and thus men are given multiple rounds of ultimately futile antibiotics and pain killers. Fortunately, other options exist.
If the nerves that lead to the testis are the issue, then often the best permanent option is a minimally invasive procedure called microsurgical spermatic cord denervation (MSCD). This is an outpatient surgical procedure performed with the assistance of high-powered magnification. The goal of surgery is to essentially strip the spermatic cord of all the nerves and structures that can cause chronic spermatic cord pain. The procedure takes approximately 45 minutes to an hour for each spermatic cord. The risks are minimal as, with excellent surgical technique and microscopic guidance, abnormal structures are identified and painstakingly excised while critical structures, such as the testicular artery, are preserved. The resulting incision is only about an inch long and located in the groin area. Patients go home the same day and are back to normal activity within a week or two.
The path to identifying a good candidate for MSCD includes a detailed medical history and physical exam with particular attention paid to previous therapies the man has had. Ultimately, the best predictor of success with this procedure is a spermatic cord block. We have developed a combination of drugs that clinicians inject directly into the spermatic cord. These medicines have both anti-inflammatory and pain controlling properties. Many men will obtain significant pain relief after the injection. Usually, this relief lasts anywhere from 48 hours to as long as a few weeks. Occasionally, a few men can even have permanent pain relief from the injection alone. Most often, a man derives temporary relief after a spermatic cord block, which indicates that he is a good candidate for MSCD. Performing MSCD in these men is approximately 75% successful in granting permanent pain relief. However, if a man gets little to no relief from the block, most likely, this man will need to see a physician specializing in chronic pain anesthesia to better address his pain.
At the end of the day, there is only one 99.9% fool-proof way to solve chronic testicular pain – surgical removal of the testis. I have yet to encounter a patient in whom this did not solve the pain completely. Of course, it is usually our last option, but it is also the most effective one. Testicles perform two functions – the production of testosterone and the production of sperm – so these are important factors to consider when embarking down this path. Although losing a testis may seem scary, rest assured that the other one usually “picks up the slack” and ultimately no significant changes to a man’s “manliness” are generally noted.
Whatever the cause of your chronic scrotal and testicular pain, rest assured that we have a solution – it is simply a matter of finding what the optimal treatment option is for your specific situation.