What is chronic testicular pain and groin pain?
A small percentage of men (or women) who have previously undergone vasectomy, hernia surgery, kidney removal, scrotal or pelvic trauma, recurrent epididymal / testicular infections, a sports hernia, or idiopathic cases present with chronic testicular pain or groin pain. This pain may range from a mild irritation to severe debilitating pain that significantly impacts the patient’s quality of life.
What causes chronic testicular pain and groin pain?
The reasons are not quite clear. One theory is that the sensory pain fibers running along the spermatic cord may for some reason have a very low stimulation threshold due to previous scrotal surgery (vasectomy), hernia surgery, kidney removal, scrotal or pelvic trauma and recurrent epididymal / testicular infections. This could be due to local irritation or inflammation along these nerve fibers. For this reason, we try conservative therapies initially since a number of patients have spontaneous resolution of the pain after a period of observation. This period may range from a few months to a few years.
The PUR Clinic’s goal is to provide maximal comfort and relief for the patient from a quality of life standpoint with minimal risk. If a patient has significant pain impacting their daily activities, more aggressive surgical intervention may be pursued after the observation period. This nerve hyper-stimulation can create extraordinary pain for the patient that is quite real, but cannot be defined as any structural abnormality by imaging modalities (these patients usually have a completely normal scrotal ultrasound).
The PUR Clinic recommendation is generally not to perform any type of exploratory procedures on patients to remove possible staples and/or remove portions of the reproductive tract (epididymis/ testis/ scar tissue, etc.), since these additional procedures can sometimes aggravate the pain by further stimulating these already dysfunctional nerve fibers. Our landmark publication identified three specific nerve fiber areas (trifecta) in the spermatic cord that showed evidence of a type of nerve sheath damage (called Wallerian Degeneration) that may explain why men develop chronic pain in this area.
Given the importance of these findings, this paper was chosen as a CME article in the July 2013 issue of the Journal of Urology. This is the first publication that suggests that there is a structural difference in men with chronic pain versus men without such pain. We still do not know what causes this change in the nerves, but we do know from the neurology literature that if patients have Wallerian Degeneration in their peripheral nerves, they may develop chronic pain in these areas.
The fundamental basis of our treatment algorithms is to specifically target these three identified nerve fiber areas (trifecta) in the cord and to preserve the bulk of the spermatic cord in order to minimize any risk to the patient. We are the only center performing such detailed, focused, targeted treatment of these nerves to eliminate or significantly reduce chronic pain in patients with chronic testicular or groin pain. The PUR Clinic’s targeted techniques differ greatly and are much less invasive than techniques utilized by most urologists.
Treatment For Testicular Pain
The PUR Clinic has developed a unique classification system to try to better measure or assess the type of pain that patients are experiencing, since each patient is unique in terms of the type of pain they may experience. Read more about our steps to Treat Testicular Pain on a new page.
What can we offer patients with chronic groin or testicular pain ?
Our center provides a unique multi-disciplinary approach to the evaluation and treatment of chronic testicular pain. Our mission is to provide the most innovative and reliable treatment options available for the management of this condition in a compassionate manner. It is a difficult condition to treat, and it sometimes requires an ongoing trial and error approach to finally reduce the pain levels. We keep striving to find new and additional treatment options to help as many patients as possible. By no means are our treatments perfect, but we will try our best to come up with a collaborative gameplan and options to alleviate pain for our patients.
Peer Reviewed Publications by our group on Chronic Groin/Testicular Pain
- Laudano M, Parekattil SJ, Li P: Microsurgical Denervation of Rat Spermatic Cord: Safety and Efficacy Data. BJU Int. 2013 Aug 23.
- Parekattil SJ, Gudeloglu A, Brahmbhatt JV, et al.: Trifecta Nerve Complex – Potential Anatomic Basis for Microsurgical Denervation of the Spermatic Cord for Chronic Orchialgia. Journal of Urology. 2013 Jan 22.
- Ramasamy R, Sterling J, Li PS, Robinson BD, Parekattil S, Chen J, Felsen D, Mukherjee S, Schlegel PN: Multiphoton imaging and laser ablation of rodent spermatic cord nerves. Journal of Urology, Feb 2012.
- ParekattilSJ, Brahmbhatt JV:Robotic approaches for male infertility and chronic orchialgia microsurgery. Curr Opin Urol. 2011 Nov;21(6):493-9.
- Parekattil SJ, Cohen MS: Robotic microsurgery 2011: male infertility, chronic testicular pain, postvasectomy pain, sports hernia pain and phantom pain. Curr Opin Urol. 2011 Mar;21(2):121-6.
- Parekattil S, Ellen JH, Priola KB, Atalah HN, Cohen MS:Video technique of Single Port and Abdominal Robotic Microsurgical Neurolysis for Chronic Groin Pain or Orchialgia. Journal of Endourology, Part B: Videourology, January 2011. doi: 10.1089/vid.2010.0118
- Parekattil SJ, Moran M: Robotic Instrumentation: Evolution & Microsurgical Applications. Special symposium-Novel instrumentation in urologic surgery.Indian J Urol. 2010 Jul;26(3):395-403.
- Parekattil SJ, Cohen MS: Robotic Microsurgery in Male infertility and Chronic Orchialgia. Curr Opin Urol. 2010 Jan;20(1):75-9.