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Reproductive system
Published in A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha, Clark’s Procedures in Diagnostic Imaging: A System-Based Approach, 2020
A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha
Patients with chronic scrotal pain and/or swelling frequently benefit from ultrasound examination, which can diagnose chronic epididymo-orchitis, scrotal hernia, varicocoele, hydrocoele, epididymal cyst as well as tumours and other conditions.
Surgical Management Techniques for Male Infertility
Published in Botros Rizk, Ashok Agarwal, Edmund S. Sabanegh, Male Infertility in Reproductive Medicine, 2019
Kevin C. Lewis, Scott Lundy, Sarah Vij
In addition to fertility, VV may also be considered for select patients with postvasectomy pain syndrome when more conservative measures have failed [31,32]. Chronic scrotal pain is a rare complication of vasectomy, occurring in approximately 1%–2% of patients [33]. The etiology remains poorly understood [34]. Patients with persistent pain despite conservative therapy may be offered a subsequent surgery, including epididymectomy, open-ended vasectomy, or VV [31,32,35]. Published data on these operations for postvasectomy pain have shown 50%–100% of patients reporting complete resolution in their pain following VV [31–33]. However, the data on reoperation for postvasectomy pain syndrome is not robust and based mainly on single-center series, and patients should be counseled appropriately [34].
Urologie Pain
Published in Mark V. Boswell, B. Eliot Cole, Weiner's Pain Management, 2005
Hossein Sadeghi-Nejad, Carin V. Hopps, Allen D. Seftel
When all other causes of chronic scrotal pain described below have been ruled out, low back strain and the resultant radiculitis due to sensory nerve root irritation at the T10 to L1 level may be the source of the discomfort. Holland et al. (Holland, Feldman, & Gilbert, 1994) have proposed that idiopathic orchalgia or “phantom orchalgia” follows an abnormal neural processing where referred scrotal pain is caused by a noxious stimulus. In these cases, the authors recommend correction of bad posture, avoidance of heavy strain or lifting, and use of a scrotal support for 6 weeks. Other recommendations include spermatic cord anesthetic infiltration at the pubic tubercle with lidocaine 1% and bupivacaine 0.5%, physiatrist referral for neuromuscular evaluation, and a possible trial of transcutaneous electrical nerve stimulation unit. Selective ilioinguinal/genitofemoral blocks or paravertebral nerve root blocks at T10 to L1 may also be attempted in refractory cases (Holland et al., 1994).
Post vasectomy chronic pain: are we under diagnosing vasitis? A case report and review of the literature
Published in The Aging Male, 2020
Adam Jones, Mahmood Vazirian-Zadeh, Yih Chyn Phan, Wasim Mahmalji
PVPS is defined as constant or intermittent testicular pain for 3 months or longer with a severity that interferes with daily activities prompting the patient to seek medical treatment [9]. The incidence of PVPS is unknown and highly variable in the literature, Leslie et al. [10] prospectively surveyed 593 men undergoing vasectomy and 14.7% of men reported chronic scrotal pain. The pathophysiology of this condition is unclear. Some of the mechanisms thought to cause PVPS include direct damage to spermatic cord, compression of nerves via inflammation, back pressure from epididymal congestion and perineural fibrosis [7]. It is a diagnosis of exclusion following clinical examination, USS and routine urinalysis [7]. Treatment is often conservative with non-steroidal anti-inflammatory drugs, tricyclic antidepressants, nerve blocks or gabapentin. If these fail, surgical intervention may be considered and include vasectomy, epididymectomy, microsurgical spermatic cord denervation and orchidectomy [5,8].