Post-vasectomy pain syndrome remains one of the more challenging urological problems to manage. This can be a frustrating process for both the patient and clinician as there is no well-recognized diagnostic regimen or...Post-vasectomy pain syndrome remains one of the more challenging urological problems to manage. This can be a frustrating process for both the patient and clinician as there is no well-recognized diagnostic regimen or reliable effective treatment. Many of these patients will end up seeing physicians across many disciplines, further frustrating them. The etiology of post-vasectomy pain syndrome is not clearly delineated. Postulations include damage to the scrotal and spermatic cord nerve structures via inflammatory effects of the immune system, back pressure effects in the obstructed vas and epididymis, vascular stasis, nerve impingement, or perineural fibrosis. Post-vasectomy pain syndrome is defined as at least 3 months of chronic or intermittent scrotal content pain. This article reviews the current understanding of post-vasectomy pain syndrome, theories behind its pathophysiology, evaluation pathways, and treatment options.展开更多
Background Chronic scrotal content pain(CSCP)is a devastating condition characterized by localized scrotal pain that persists for≥3 months and interferes with daily activities.Approximately 2.5%of all urology outpati...Background Chronic scrotal content pain(CSCP)is a devastating condition characterized by localized scrotal pain that persists for≥3 months and interferes with daily activities.Approximately 2.5%of all urology outpatient visits are associated with CSCP.General urologists may have difficulty treating these patients because of uncertainties regarding the etiology and pathophysiology of CSCP.Therefore,we aimed to provide a simplified diagnostic and treatment approach for CSCP by subdividing it into distinct categories.Materials and methods We systematically reviewed the published literature in the PubMed,MEDLINE,and Cochrane databases for all reports on CSCP diagnosis and treatment using the keywords“chronic scrotal content pain,”“testicular pain,”“orchialgia,”“testicular pain syndrome,”“microdenervation of the spermatic cord,”“post-vasectomy pain syndrome,”“post-inguinal hernia repair pain,”“testialgia,”and“pudendal neuralgia.”This review included only CSCP-related articles published in English language.Results We subdivided CSCP syndrome into 5 clinical presentation types,including hyperactive cremasteric reflex,pain localized in the testicles,pain in the testis,spermatic cord,and groin,pain localized in the testicles,spermatic cord,groin,and pubis,and pain in the testicles,spermatic cord/groin,and penis/pelvis.Treatments were adjusted stepwise for each type and section.We included more information regarding the role of pudendal neuroglia in CSCP syndrome and discussed more options for nerve blocks for CSCP.For microsurgical spermatic cord denervation failure,we included treatment options for salvage ultrasound-guided targeted cryoablation,Botox injections,and posterior-inferior scrotal denervation.Conclusions Different CSCP subtypes could help general urologists assess the appropriate diagnostic and treatment approaches for scrotal pain management in daily practice.展开更多
文摘Post-vasectomy pain syndrome remains one of the more challenging urological problems to manage. This can be a frustrating process for both the patient and clinician as there is no well-recognized diagnostic regimen or reliable effective treatment. Many of these patients will end up seeing physicians across many disciplines, further frustrating them. The etiology of post-vasectomy pain syndrome is not clearly delineated. Postulations include damage to the scrotal and spermatic cord nerve structures via inflammatory effects of the immune system, back pressure effects in the obstructed vas and epididymis, vascular stasis, nerve impingement, or perineural fibrosis. Post-vasectomy pain syndrome is defined as at least 3 months of chronic or intermittent scrotal content pain. This article reviews the current understanding of post-vasectomy pain syndrome, theories behind its pathophysiology, evaluation pathways, and treatment options.
文摘Background Chronic scrotal content pain(CSCP)is a devastating condition characterized by localized scrotal pain that persists for≥3 months and interferes with daily activities.Approximately 2.5%of all urology outpatient visits are associated with CSCP.General urologists may have difficulty treating these patients because of uncertainties regarding the etiology and pathophysiology of CSCP.Therefore,we aimed to provide a simplified diagnostic and treatment approach for CSCP by subdividing it into distinct categories.Materials and methods We systematically reviewed the published literature in the PubMed,MEDLINE,and Cochrane databases for all reports on CSCP diagnosis and treatment using the keywords“chronic scrotal content pain,”“testicular pain,”“orchialgia,”“testicular pain syndrome,”“microdenervation of the spermatic cord,”“post-vasectomy pain syndrome,”“post-inguinal hernia repair pain,”“testialgia,”and“pudendal neuralgia.”This review included only CSCP-related articles published in English language.Results We subdivided CSCP syndrome into 5 clinical presentation types,including hyperactive cremasteric reflex,pain localized in the testicles,pain in the testis,spermatic cord,and groin,pain localized in the testicles,spermatic cord,groin,and pubis,and pain in the testicles,spermatic cord/groin,and penis/pelvis.Treatments were adjusted stepwise for each type and section.We included more information regarding the role of pudendal neuroglia in CSCP syndrome and discussed more options for nerve blocks for CSCP.For microsurgical spermatic cord denervation failure,we included treatment options for salvage ultrasound-guided targeted cryoablation,Botox injections,and posterior-inferior scrotal denervation.Conclusions Different CSCP subtypes could help general urologists assess the appropriate diagnostic and treatment approaches for scrotal pain management in daily practice.
