Pain in the testicles is a fairly common condition treated by urologists. Causes frequently include: infection of the testicle (orchitis) or epididymis (epididymitis), post surgical pain, trauma, tumors, hernia, torsion (twisting of the testicle), varicocele (varicose veins of the testicle), hydrocele or spermatocele. Most of these conditions are easily diagnosed and treated.
Occasionally, even when treated appropriately, the pain becomes chronic. In up to 25% of patients with chronic testicular pain, no cause can be found.
Treatment for Chronic Testicular Pain
When Dr. Werthman sees patients for chronic testicular pain, he will make certain that they undergo diagnostic tests such as scrotal ultrasound. Initial treatment is usually conservative, consisting of antibiotics and anti-inflammatory medications.
If the pain does not diminish with conservative treatment, a new surgical technique has been developed that resolves most testicular pain while preserving the testicle. This procedure is known as microsurgical denervation of the spermatic cord or “cord stripping.”
When Dr. Werthman performs this procedure, he makes a small incision (2 inches) in the groin and, under the operating microscope, separates all the structures in the spermatic cord, including the veins, nerves and vas deferens. The arteries to the testicle and lymphatics are left intact. This is very similar to the microsurgical varicocele repair, except that the vas is cut as well as the veins.
Complete pain relief can be expected in 75% of appropriately selected patients and partial relief in 9%. The procedure is performed in an outpatient facility and takes 45 minutes. Recovery time is between two and five days.
Microsurgical spermatic cord denervation offers a successful treatment option for men with chronic testicular pain, while preserving the testicle. At the Center for Male Reproductive Medicine, we are pleased to help those who come to us with chronic testicular pain using this procedure.