Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-78c5997874-fbnjt Total loading time: 0 Render date: 2024-11-08T00:13:20.507Z Has data issue: false hasContentIssue false

Chapter 42 - Evidence-Based Management of Chronic Orchialgia and Chronic Prostatitis/Chronic Pelvic Pain Syndrome

from Section 5 - Medical and Surgical Management of Issues of Male Health

Published online by Cambridge University Press:  06 December 2023

By
Sharon P. Lo  and
Kelli X. Gross
Edited by
Douglas T. Carrell ,
Alexander W. Pastuszak  and
James M. Hotaling
Douglas T. Carrell
Affiliation:
Utah Center for Reproductive Medicine
Alexander W. Pastuszak
Affiliation:
University of Utah
James M. Hotaling
Affiliation:
Utah Center for Reproductive Medicine
Get access

Summary

Chronic pain genital pain in men generally falls into chronic testicular pain or chronic prostatitis/chronic pelvic pain (CP/CPPS), which has considerable overlap. This is a common complaint, but the etiology, treatment, and response to treatment vary widely. There is still a paucity of high-quality data regarding chronic orchialgia and CP/CPPS, but a widening variety of treatment options is coming to light. We review the etiology and treatment options.

Keywords

male chronic testicular painchronic orchialgiamicroscopic spermatic cord denervationCP/CPPSchronic prostatitischronic pelvic pain syndrome
Type
Chapter
Information
Men's Reproductive and Sexual Health Throughout the Lifespan
An Integrated Approach to Fertility, Sexual Function, and Vitality
 , pp. 329 - 336
Publisher: Cambridge University Press
Print publication year: 2023

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Sigalos, JT, Pastuszak, AW. Chronic orchialgia: epidemiology, diagnosis and evaluation. Transl Androl Urol. 2017;6:S37–S43.CrossRefGoogle ScholarPubMed
Wagenlehner, FM, van Till, JW, Magri, V, et al. National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) symptom evaluation in multinational cohorts of patients with chronic prostatitis/chronic pelvic pain syndrome. Eur Urol. 2013;63:953–959.Google Scholar
Schover, LR. Psychological factors in men with genital pain. Cleve Clin J Med. 1990;57:697–700.Google Scholar
Costabile, RA, Hahn, M, McLeod, DG. Chronic orchialgia in the pain prone patient: the clinical perspective. J Urol. 1991;146:1571–1574.Google Scholar
Ciftci, H, Savas, M, Gulum, M, Yeni, E, Verit, A, Topal, U. Evaluation of sexual function in men with orchialgia. Arch Sex Behav. 2011;40:631–634.Google Scholar
Patel, AP. Anatomy and physiology of chronic scrotal pain. Transl Androl Urol. 2017;6:S51–S56.Google Scholar
Hunter, CW, Stovall, B, Chen, G, Carlson, J, Levy, R. Anatomy, pathophysiology and interventional therapies for chronic pelvic pain: a review. Pain Physician. 2018;21:147–167.Google Scholar
Chaudhari, R, Sharma, S, Khant, S, Raval, K. Microsurgical denervation of spermatic cord for chronic idiopathic orchialgia: long-term results from an institutional experience. World J Mens Health. 2019;37:78–84.Google Scholar
Nickel, JC, Shoskes, D, Wang, Y, et al. How does the pre-massage and post-massage 2-glass test compare to the Meares-Stamey 4-glass test in men with chronic prostatitis/chronic pelvic pain syndrome? J Urol. 2006;176:119–124.Google Scholar
Lau, MW, Taylor, PM, Payne, SR. The indications for scrotal ultrasound. Br J Radiol. 1999;72:833–837.Google Scholar
Davis, BE, Noble, MJ, Weigel, JW, Foret, JD, Mebust, WK. Analysis and management of chronic testicular pain. J Urol. 1990;143:936–939.CrossRefGoogle ScholarPubMed
Levine, LA, Matkov, TG, Lubenow, TR. Microsurgical denervation of the spermatic cord: a surgical alternative in the treatment of chronic orchialgia. J Urol. 1996;155:1005–1007.Google Scholar
Parekattil, SJ, Gudeloglu, A, Brahmbhatt, JV, Priola, KB, Vieweg, J, Allan, RW. Trifecta nerve complex: potential anatomical basis for microsurgical denervation of the spermatic cord for chronic orchialgia. J Urol. 2013;190:265–270.Google Scholar
Benson, JS, Abern, MR, Larsen, S, Levine, LA. Does a positive response to spermatic cord block predict response to microdenervation of the spermatic cord for chronic scrotal content pain? J Sex Med. 2013;10:876–882.Google Scholar
Oliveira, RG, Camara, C, Alves, JMAF, Coelho, RF, Lucon, AM, Srougi, M. Microsurgical testicular denervation for the treatment of chronic testicular pain initial results. Clinics (Sao Paulo). 2009;64:393–396.Google Scholar
Marconi, M, Palma, C, Troncoso, P, Dell Oro, A, Diemer, T, Weidner, W. Microsurgical spermatic cord denervation as a treatment for chronic scrotal content pain: a multicenter open label trial. J Urol. 2015;194:1323–1327.Google Scholar
Calixte, N, Kartal, IG, Tojuola, B, et al. Salvage ultrasound-guided targeted cryoablation of the perispermatic cord for persistent chronic scrotal content pain after microsurgical denervation of the spermatic cord. Urology. 2019;130:181–185.CrossRefGoogle ScholarPubMed
Calixte, N, Brahmbhatt, J, Parekattil, S. Chronic testicular and groin pain: pathway to relief. Curr Urol Rep. 2017;18:83.Google Scholar
Padmore, DE, Norman, RW, Millard, OH. Analyses of indications for and outcomes of epididymectomy. J Urol. 1996;156:95–96.Google Scholar
Hori, S, Sengupta, A, Shukla, CJ, Ingall, E, McLoughlin, J. Long-term outcome of epididymectomy for the management of chronic epididymal pain. J Urol. 2009;182:1407–1412.Google Scholar
Peterson, AC, Lance, RS, Ruiz, HE. Outcomes of varicocele ligation done for pain. J Urol. 1998;159:1565–1567.Google Scholar
Park, HJ, Lee, SS, Park, NC. Predictors of pain resolution after varicocelectomy for painful varicocele. Asian J Androl. 2011;13:754–758.Google Scholar
Kim, HT, Song, PH, Moon, KH. Microsurgical ligation for painful varicocele: effectiveness and predictors of pain resolution. Yonsei Med J. 2012;53:145–150.Google Scholar
Sharlip, ID, Belker, AM, Honig, S, et al. Vasectomy: AUA guideline. J Urol. 2012;188:2482–2491.Google Scholar
Leslie, TA, Illing, RO, Cranston, DW, Guillebaud, J. The incidence of chronic scrotal pain after vasectomy: a prospective audit. BJU Int. 2007;100:1330–1333.Google Scholar
Morris, C, Mishra, K, Kirkman, RJ. A study to assess the prevalence of chronic testicular pain in post-vasectomy men compared to non-vasectomised men. J Fam Plann Reprod Health Care. 2002;28:142–144.Google Scholar
Smith-Harrison, LI, Smith, RP. Vasectomy reversal for post-vasectomy pain syndrome. Transl Androl Urol. 2017;6:S10–S13.Google Scholar
Tan, WP, Tsambarlis, PN, Levine, LA. Microdenervation of the spermatic cord for post-vasectomy pain syndrome. BJU Int. 2018;121:667–673.CrossRefGoogle ScholarPubMed
Shoskes, DA, Berger, R, Elmi, A, et al. Muscle tenderness in men with chronic prostatitis/chronic pelvic pain syndrome: the chronic prostatitis cohort study. J Urol. 2008;179:556–560.Google Scholar
Riegel, B, Bruenahl, CA, Ahyai, S, Bingel, U, Fisch, M, Lowe, B. Assessing psychological factors, social aspects and psychiatric co-morbidity associated with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) in men – a systematic review. J Psychosom Res. 2014;77:333–350.Google Scholar
Anderson, RU, Wise, D, Nathanson, BH. Chronic prostatitis and/or chronic pelvic pain as a psychoneuromuscular disorder: a meta-analysis. Urology. 2018;120:23–29.Google Scholar
Nickel, JC, Alexander, RB, Schaeffer, AJ, et al. Leukocytes and bacteria in men with chronic prostatitis/chronic pelvic pain syndrome compared to asymptomatic controls. J Urol. 2003;170:818–822.Google Scholar
Hou, DS, Long, WM, Shen, J, Zhao, LP, Pang, XY, Xu, C. Characterisation of the bacterial community in expressed prostatic secretions from patients with chronic prostatitis/chronic pelvic pain syndrome and infertile men: a preliminary investigation. Asian J Androl. 2012;14:566–573.Google Scholar
Pontari, MA, McNaughton-Collins, M, O’Leary, MP, et al. A case-control study of risk factors in men with chronic pelvic pain syndrome. BJU Int. 2005;96:559–565.Google Scholar
Shoskes, DA, Altemus, J, Polackwich, AS, Tucky, B, Wang, H, Eng, C. The urinary microbiome differs significantly between patients with chronic prostatitis/chronic pelvic pain syndrome and controls as well as between patients with different clinical phenotypes. Urology. 2016;92:26–32.Google Scholar
Murphy, SF, Anker, JF, Mazur, DJ, Hall, C, Schaeffer, AJ, Thumbikat, P. Role of gram-positive bacteria in chronic pelvic pain syndrome (CPPS). Prostate. 2019;79:160–167.Google Scholar
Pontari, MA, Ruggieri, MR. Mechanisms in prostatitis/chronic pelvic pain syndrome. J Urol. 2004;172:839–845.Google Scholar
Anderson, RU, Orenberg, EK, Chan, CA, Morey, A, Flores, V. Psychometric profiles and hypothalamic-pituitary-adrenal axis function in men with chronic prostatitis/chronic pelvic pain syndrome. J Urol. 2008;179:956–960.Google Scholar
Antolak, SJ, Hough, DM, Pawlina, W, Spinner, RJ. Anatomical basis of chronic pelvic pain syndrome: the ischial spine and pudendal nerve entrapment. Medical Hypotheses. 2002;59:349–353.Google Scholar
Shoskes, DA, Albakri, Q, Thomas, K, Cook, D. Cytokine polymorphisms in men with chronic prostatitis/chronic pelvic pain syndrome: association with diagnosis and treatment response. J Urol. 2002;168:331–335.Google Scholar
Dellabella, M, Milanese, G, Muzzonigro, G. Correlation between ultrasound alterations of the preprostatic sphincter and symptoms in patients with chronic prostatitis-chronic pelvic pain syndrome. J Urol. 2006;176:112–118.Google Scholar
Mehik, A, Hellström, P, Nickel, JC, et al. The chronic prostatitis-chronic pelvic pain syndrome can be characterized by prostatic tissue pressure measurements. J Urol. 2002;167:137–140.Google Scholar
Arisan, ED, Arisan, S, Kiremit, MC, et al. Manganese superoxide dismutase polymorphism in chronic pelvic pain syndrome patients. Prostate Cancer Prostatic Dis. 2006;9:426–431.Google Scholar
Chen, X, Hu, C, Peng, Y, et al. Association of diet and lifestyle with chronic prostatitis/chronic pelvic pain syndrome and pain severity: a case-control study. Prostate Cancer Prostatic Dis. 2016;19:92–99.Google Scholar
Capodice, JL, Bemis, DL, Buttyan, R, Kaplan, SA, Katz, AE. Complementary and alternative medicine for chronic prostatitis/chronic pelvic pain syndrome. Evid Based Complement Alternat Med. 2005;2:495–501.Google Scholar
Shoskes, DA, Zeitlin, SI, Shahed, A, Rajfer, J. Quercetin in men with category III chronic prostatitis: a preliminary prospective, double-blind, placebo-controlled trial. Urology. 1999;54:960–963.Google Scholar
Wagenlehner, FM, Schneider, H, Ludwig, M, Schnitker, J, Brahler, E, Weidner, W. A pollen extract (Cernilton) in patients with inflammatory chronic prostatitis-chronic pelvic pain syndrome: a multicentre, randomised, prospective, double-blind, placebo-controlled phase 3 study. Eur Urol. 2009;56:544–551.Google Scholar
Chuang, YC, Tu, CH, Huang, CC, et al. Intraprostatic injection of botulinum toxin type-A relieves bladder outlet obstruction in human and induces prostate apoptosis in dogs. BMC Urol. 2006;6:12.CrossRefGoogle ScholarPubMed
McNaughton Collins, M, Wilt, TJ. Allopurinol for chronic prostatitis. Cochrane Database Syst Rev. 2002;2002(4):CD001041.Google Scholar
Kim, HW, Roh, DH, Yoon, SY, et al. The anti-inflammatory effects of low- and high-frequency electroacupuncture are mediated by peripheral opioids in a mouse air pouch inflammation model. J Altern Complement Med. 2006;12:39–44.Google Scholar
Gao, M, Ding, H, Zhong, G, et al. The effects of transrectal radiofrequency hyperthermia on patients with chronic prostatitis and the changes of MDA, NO, SOD, and Zn levels in pretreatment and posttreatment. Urology. 2012;79:391–396.Google Scholar
Fitzgerald, MP, Anderson, RU, Potts, J, et al. Randomized multicenter feasibility trial of myofascial physical therapy for the treatment of urological chronic pelvic pain syndromes. J Urol. 2013;189:S75–S85.CrossRefGoogle ScholarPubMed
Mykoniatis, I, Pyrgidis, N, Sokolakis, I, et al. Low-intensity shockwave therapy for the management of chronic prostatitis/chronic pelvic pain syndrome: a systematic review and meta-analysis. BJU Int. 2021;128(2):144–152.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×