(81-86(

KAJ( Kurdistan Academicians Journal, March 2006, 4(1( part A(

)86-81 ( ‫لثةرة‬
A ‫) بةشى‬1( ‫ ذ‬4 ‫ بةرط‬,2006 ‫ ئازاري‬- 2706 ‫ نةوروزي‬-‫طؤظارى ئةكاديميانى كوردستان‬

Orchalgia

Aso Omar Rashid

College of Medicine University of Sluaimani Kurdistan Region, Iraq

Abstract
Chronic testicular pain with out sings and etiology has no definite treatment, remain as a challenge to
the urologist. Methods: This is a prospective study on 100 patients with chronic testicular pain and no
detectable testicular pathology seen over a 5-year period. They were all evaluated with routine
laboratory tests and radiological study. No operation were performed for any of them. Results: No
specific cause was identified in most of the cases. Unilateral testis affected in 83cases, right side involved
in47 cases, pain was unrelated to the type of their work and happens more at night. They didn’t show
response to conservative treatment. Conclusion: Wide spectrum of presentation had relatively no great
improvement. Treatment of the patient with chronic testicular pain is difficult and often unrewarding. We
believe that extensive diagnostic tests are not indicated in the absence of clinical findings and may serve
to worsen the condition or lead to iatrogenic injury. Surgical intervention should be limited to cases with
clear cut indications.

Keywords:- orchalgia, testalgia, chronic testicular pain syndrom, testis pain.

Introduction antidepressant drugs before opiate

Chronic unilateral or bilateral
orchialgia; defined as intermittent or
constant testicular pain of longer than
3 months and of unclear cause,
significantly interferes with the daily
activities of the patient .[1] It is intra-
scrotal of unknown etiology, worsened
by testicular palpation.[2] Some describe
it as testodynia which may be a
psychosomatic disease, The stress
causes alpha 1-receptor mediated,
contraction of smooth muscle in the vas
deferens and epididymis.[3]The
pathophysiology of the pain is poorly
understood probably an alternative
autonomic pathway may exists.[4]
Reported success rates of 55-73 %
and10 –40% of conservative and surgical
interventions are extremely low .[5]
Spermatic cord block and transcutaneous
electrical nerve stimulation may help
relieve pain although it often recurs .
Antidepressants sometimes relieve pain.
Many patients benefit from a program at
a multidisciplinary pain-management
clinic and should receive these
Email: aso622003@yahoo.com
therapy is prescribed. When all
conservative efforts have failed and
testicular pain continues to affect the
patient's quality of life, orchiectomy may
have to be considered.[6] Some times
seen in men who have become sexually
exited without opportunity to ejaculate,
or it`s referred pain from a renal
calculus, or a leaking aneurysm , and
drugs, e.g. mazindol .May follow
vasectomy. [7] Prior to vasectomy, all
patients should be counseled with regard
to the risk of chronic testicular pain.[8] A
complication; ipsilateral orchialgia after
laparoscopic donor nephrectomy have
been reported, may be due to injury to
the sensory nerves of the testicle during
dissection of the periureteral tissue or
transection of the spermatic cord.[9]
Radiculitis that is caused by low back
strain may lead to testicular pain.
Treatment directed to relieve sensory
nerve root irritation at the T10 to L1
levels is often successful.[10] Uricemia,
the hypothesis of an intracanalicular
deposit o f uric crystals and / or the

81
KAJ( Kurdistan Academicians Journal, March 2006, 4(1( part A(
A ‫) بةشى‬1( ‫ ذ‬4 ‫ بةرط‬,2006 ‫ ئازاري‬- 2706 ‫ نةوروزي‬-‫طؤظارى ئةكاديميانى كوردستان‬

resulting alteration in nerve endings is pain to the activities, rest and intercourse
suggested , its determination should were identified. Associated urological
become routine.[11] But testicular symptomatology , specific treatment and
microlithiasis cannot be considered to results of therapies asked and recorded.
be an etiological factor in orchidalgia Physical examination; general and local
.[12] Chronic orchalgia is a diagnosis of were done including both testes, looking
exclusion for which a multidisciplinary for any abnormality, all patients had;
approach may be rewarding urinanalysis, culture of urine, ultrasound
.[13]Scrotal ultrasound scanning is now a examination of the abdomen and testes
routine and mandatory investigation for with special attention to the urinary tract.
the patient presenting with scrotal Color-coded doppler-sonography was
symptoms.[14] Various operations used in all cases. Blood examination:
advocated in the literature for non – WBC, ESR. and plain X-Ray of the
responders include epididymectomy, abdomen were taken. Seventeen
orchiectomy , all of which have a patients presented after they had surgical
significant failure rate.[15] The treatment.Patients with abnormal X-ray
management of chronic pain syndromes or ultrasound were excluded from the
is often coordinated by study and, all the cases with clear
anesthesiologists.[16] Stripping testicular clinical findings like varicocele
(denervation) of the spermatic , epididemitis , torsion ,history of trauma
cord.[17]or in microsurgical testicular and hydrocele were excluded. We didn’t
denervation , the high success rate of operate on any patients.
these surgical procedure can only be All the patients including those who had
maintained if the selection of a operations, received conservative
suitable patients is performed.[5] treatment in the form of reassurance and
100 mg. diclofenac Na. tablet once daily
Patients and methods for one week and on need and use of hot
A total of 100 patients were seen in bath or application. The patients were
consultation clinic between 4th. May advised to came back after one week for
1997 and 20th.December 2001 for assessment.
chronic unilateral or bilateral testicular Results
pain, described as, intermittent or Age of the patients ranges from 17-42
constant testicular pain for 3 months or years (mean is 25.6), period of illness 3
longer in duration that significantly month to 19 month. Unilateral in;83,
interferes with the daily activities of the bilateral in;17, right side;47, left side;36,
patient so as to prompt him to seek founded among heavy duty person;28
medical attention. History were taken and unrelated in;57 patients. Time of
including timing ,onset , duration , side occurance in most of them was at night.
,severity of the pain. Relation of the
Table-1: Occupational distribution.
Shepherd 2 Car 4 Male nurse 1
mechanic
Military 3 Driver 5 Teacher 2
Self 23 Athletic 6 Policeman 1
employed
Farmer 8 Butcher 18 student 23
Clerk 2 Shop-keeper 2

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KAJ( Kurdistan Academicians Journal, March 2006, 4(1( part A(
A ‫) بةشى‬1( ‫ ذ‬4 ‫ بةرط‬,2006 ‫ ئازاري‬- 2706 ‫ نةوروزي‬-‫طؤظارى ئةكاديميانى كوردستان‬

Table-2 :Number of the patients had operation before their presentation.

Laparotom 2 Varicocelect 9(Right 6) Herniotomy 3 (Right)
y omy (Left 3)
Hydrocele 1 Trauma Zero haemorrhoi 2
ctomy dectomy
One had 4-time varicocelectomy on his diet plus Allopurinol 300 mg/day, and
right side. GUE and culture of urine , symptoms receded in 81.06% cases.[11]
WBC and ESR were normal in all of Deck AJ,present three patients with
them, and none of them got benefit from chronic testicular pain due to retractile
analgesia, all described temporary testes and relieved by pushing the testicle
improvement by hot application . into the scrotum.[15] In 1999 , Cadeddu
Plain X-ray of the abdomen , ultrasound JA, described trans- peritoneal
of the abdomen and testes were normal . laparoscopic testicular denervation for
nine patients with chronic orchialgia.
Discussion He provided temporary relief in all nine
From the study we founded that the patients.[19] Hahn M, reviewed the
chronic testicular pain occur more in records of 48 patients with chronic
right side and it is unilateral rather than testicular pain, he founded little
bilateral .It is unrelated to daily activities improvement of these patients after
in 57 patients but there is association multiple surgical procedures.[20] Devine
with exertion in 28 patients. More at CJ et. al. use microsurgical denervation
night where they come home for rest . of the spermatic cord for orchialgia in
It is more evident among self employed 2 patients in an effort to achieve this goal
,student and butchers. Varicocelectomy is without sacrifice of the testes.[2] Brooks
the commoner operation among them, JD, reported embolization of a
non of our patients showed improvement varicocele for chronic testicular pain and
to medical therapy. Davis BE et al . , developed increased bilateral testicular
analyzed 34 patients with chronic pain. Complete pain relief was achieved
testicular pain .Of the patients31 by laparoscopic resection of both
underwent surgical treatment after failure spermatic cords. [21] West AF, advised
of medical management;24 epididymectome in well-selected patients
orchiectomies , 10 epididymectomies , 5 as a reliable and effective treatment for
orchiopexies and 1 hydrocelectomy.[18] pain relief after vasectomy.[22]Sasaki K
Yamamoto M, had 12 patients with described Oral gabapentin (neurontin) an
chronic orchialgia.Four patients anticonvulsant with therapeutic effects
underwent inguinal orchiectomy three for treatment of orchalgia. He founded 10
reported complete relief of pain. Two of of 21 improvement.[23]
his patients had bilateral trans-rectal
injections of local anesthesia. He Conclusion
recommended transrectal blockade of We believe that extensive diagnostic
pelvic nerves plexus or inguinal testing is not indicated in the absence
orchiectomy as the procedure of of clinical findings and may serve to
choice.[1] Lopez Laur JD Studied 60 worsen the condition or lead to
patients with chronic orchialgia. iatrogenic injury. Surgical intervention
Hyperuricemia was corroborated in 61.6 should be limited to cases when a
% cases. Based on figures found, clear indication is present.
patients were treated with a low-purine

83
KAJ( Kurdistan Academicians Journal, March 2006, 4(1( part A(
A ‫) بةشى‬1( ‫ ذ‬4 ‫ بةرط‬,2006 ‫ ئازاري‬- 2706 ‫ نةوروزي‬-‫طؤظارى ئةكاديميانى كوردستان‬

Acknowledgements

I thank Dr. Taher Aref, for his assistance in radiological examinations.

References
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of the spermatic cord for orchialgia.Trans Am Assoc Genitourin Surg
1978;70:149-51
3. Ugeskr Laeger ,Essential testodynia ,1998 14;160(51):7444-6.
4. M.Masarani,R.COX.The etiology,pathophysiology and management of
chronic orchalgia. BJU Int.2003;91,435-437.
5. HeidenreichA, ZumbeJ, MartinezF, GrozingerKEngelmannUH80
[Microsurgical testicular denervation as therapy option in chronic
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6. Baum N, Defidio L Chronic testicular pain. A workup and treatment
guide for the primary care-physician.PostgradMed,1995.;98(4):151-
3,156-8
7. John Blandy,Christopher Fowler.UROLOGY Sec.ed.,1996,573-
5,Blackwell
Science Ltd.Osney Mead, Oxford OX2 0EL,25 John Street,LondonWC1N
2BL.
8. McMahon AJ, Buckley J, Taylor A, Lloyd SN, Deane RF, Kirk D Chronic
testicular pain following Br J Urol 1992;69(2):188-91 vasectomy.
9. Kim FJ, Pinto P, Su LM, Jarrett TW, Rattner LE, Montgomery R, Kavoussi
LR.Ipsilateral orchialgia after laparoscopic donor nephrectomy. J Endourol.
2003;17(6):405-9.
10. Holland JM, Feldman JL, Gilbert HC 65: Phantom orchalgia. J Urol
1994;152(6 Pt 2):2291-3
11. Lopez Laur JD, Chiapetta Menendez J Chronic orchialgia. A diagnostic
and
therapeutic hypothesis. Actas Urol Esp 1997;21(8):770-2
12. Jara Rascon J, Escribano Patino G, Herranz Amo F, Moncada Iribarren
I,
Hernandez Fernandez C.Testicular microlithiasis: diagnosis associated
With orchialgia. Arch Esp Urol 1998;51(1):82-5
13. Hayden LJ. Chronic testicular pain. Aust Fam Physician 1993;22(8):1357-
9, 1362, 1365
14. Lau MW, Taylor PM, Payne SR.The indications for scrotal ultrasound.
Br J Radiol 1999;72(861):833-7
15. Deck AJ, Berger RE. Pain associated with testicular retraction treated
with Gore- Tex external inguinal ring reconstruction. Tech Urol

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1999;5(4):219-22
16. Kennedy EM, Harms BA, Starling JR. Absence of maladaptive
neuronal
plasticity after genitofemoral-ilioinguinal neurectomy.Surgery
1994;116(4):665- 70; discussion 670-1
17. Ahmed I, Rasheed S, White C, Shaikh NA. The incidence of post-
vasectomy chronic testicular pain and the role of nerve stripping
(denervation) of the spermatic cord in its management. Br J Urol
1997;79(2):269-70
18. Davis BE, Noble MJ, Weigel JW, Foret JD, Mebust WK. Analysis and
management of chronic testicular pain. J Urol 1990;143(5):936-9
19. Cadeddu JA, Bishoff JT, Chan DY, Moore RG, Kavoussi LR, Jarrett
TW:
Laparoscopic testicular denervation for chronic orchalgia J Urol
1999;162(1):733-5..
20. Costabile RA, Hahn M, McLeod DG. Chronic orchialgia in the pain prone
patient: the clinical perspective. J Urol 1991;146(6):1571-4
21. Brooks JD, Moore RG, Kavoussi LR. Laparoscopic management of
testicular pain after embolotherapy of varicocele. J Endourol
1994;8(5):361-3
22. West AF, Leung HY, Powell PH Epididymectomy is an effective treatment
for scrotal pain after vasectomy. BJU Int. 2000;85(9):1097-9.
23. Sasaki K, Smith CP, Chuang YC, Lee JY, Kim JC, Chancellor MB. Oral
gabapentin (neurontin) treatment of refractory genitourinary tract pain.
Tech Urol. 2001;(1):47-9.

85
‫(‪KAJ( Kurdistan Academicians Journal, March 2006, 4(1( part A‬‬
‫طؤظارى ئةكاديميانى كوردستان‪ -‬نةوروزي ‪ - 2706‬ئازاري ‪ ,2006‬بةرط ‪ 4‬ذ (‪ )1‬بةشى ‪A‬‬

‫ئازارى باتووى كونينة‬

‫ئاسو عومةر رشيد‬

‫كوليجي ثزيشكي ‪ /‬زانكؤي سليَماني‪ /‬هةريمي كوردستان‪ -‬عيراق‬
‫ثوختة‬
‫له ‪ 100‬نه خوش له نه خوشخانه ى ضوارباخى فيركارى كه ئازارى وه ته يان له ‪3‬‬
‫مانننك زياتننر هننه بووه كوَكرايننه وه ‪ ,‬باش بشكنينننى جوَراوجوَر‪ ,‬هيننج هوَ نيه ك نننه‬
‫دوَزراية وه نه ده رمان نه نه شته ر طة رى سوودى نه بووه ئي َمة وا به باش ئه‬
‫زانينن كنه ئه م ننه خوَشاننة دلنيابكريننه وه وه بنه يوه ندى ئازاره كنه بنه ده مارى‬
‫باتووه وه روون بكريتننه وه ‪ .‬هننه نديَكيان بيَويسننتيان بننه راوَيذى طروثننة ثزيشكيننة‬
‫( كورجيله وميزه روكان و ثزيشكى به نج ) ئه بيت‪ .‬كه ميَكيان بيَويستيان به برينى ده‬
‫مارى باتوو ئه بيت‪.‬‬
‫الم الخـصيـة المـزمنــة‬
‫آسو عمر رشيد‬
‫كلية الطب‪ /‬جامعة السليمانية‪ /‬اقليم كوردستان‪ -‬العراق‬
‫الخلصة‬
‫اجريت هده الدراسة لمئة مرضى فى السليمانية ‪ ,‬كانو قد اصيبو بهده المرض لكثر‬
‫من ‪ 3‬اشهر‪ ,‬وتبين من نتائج فحوصات وعلج هولء المرضى ومتابعتهم التى استغرقت‬
‫‪ 5‬سنين انه لتوجت اية اسباب ملموسه لهده اللم و انما هناك عدة عوامل قد تتشارك‬
‫والصابة بهده المرض‪ ,‬وان اى محاولة لعلج هده المرض بالدوية المسكنة غير‬
‫مرضية وتكون السوء عند اى محاولة للعلج باستعمال الجراحة مثل عملية الدولي ‪,‬‬
‫الفتق‪,‬استكشاف الخصية حينها ويتم العلج بتوضيح صورة المرض بان السبب الحقيقى‬
‫تكمن وراء عصب الخصية التى تعمل بصورة خاطئة فى ايصال اليعازات‪ .‬وتخفيف‬
‫اللم يتم باشتراك طبيب البولية مع طبيب معالج اللم ‪ ,‬او بطريقة تخفيف اللم‬
‫بعزل عصب الخصية جراحيا‪.‬‬

‫‪Received on 30/5/2004, Accepted 21/6/2005‬‬

‫‪21/6/2005‬‬ ‫وةرطيرا لة ‪ 30/5/2004‬ثةسندكراوة لة‬

‫‪86‬‬
‫(‪KAJ( Kurdistan Academicians Journal, March 2006, 4(1( part A‬‬
‫طؤظارى ئةكاديميانى كوردستان‪ -‬نةوروزي ‪ - 2706‬ئازاري ‪ ,2006‬بةرط ‪ 4‬ذ (‪ )1‬بةشى ‪A‬‬

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