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Momenzadeh C, Razzaghi M, Ommi D, Birami J. Effectiveness of Low-Level Laser Therapy in Orchialgia After Varicocelectomy Surgery. J Lasers Med Sci 2024; 15:e35. [PMID: 39193107 PMCID: PMC11348440 DOI: 10.34172/jlms.2024.35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Accepted: 06/15/2024] [Indexed: 08/29/2024]
Abstract
Introduction: The management of chronic groin and scrotal content pain (orchialgia) is a complex condition after varicocelectomy that is encountered by most practicing clinicians. The aim of this study was to evaluate the effectiveness of low-level laser therapy (LLLT) in orchialgia after varicocelectomy surgery. Methods: This study was performed as a double-blind, placebo-controlled randomized clinical trial in which sixty patients with orchialgia after varicocelectomy were randomly divided into three groups of 20 as follows: (1) low-level laser group with red (650 nm, 50 mW), (2) low-level laser group with infrared (IR) (820 nm, 100 mW), and (3) laser placebo group. The treatment protocol consisted of 15 minutes, three times a week, for only 12 sessions. Then, the patients were evaluated for pain and sexual satisfaction during the 12-week follow-up. Results: The pain score in the two groups of low-level laser with red light and IR spectra showed a significant relief (P<0.05) 6 and 12 weeks after starting the treatment, In addition, a significant increase was observed in the level of sexual satisfaction in the red and infrared spectra LLLT groups (P<0.05). Conclusion: We concluded that the use of LLLT with red light (650 nm, 50 mW)/IR (820 nm, 100 mW) spectra with power of 6-25 J/cm2/day in 15 minutes, three times a week, for 12 sessions can significantly reduce pain and increase sexual satisfaction in these patients.
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Affiliation(s)
- Cyrus Momenzadeh
- Laser Application in Medical Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Razzaghi
- Laser Application in Medical Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Davod Ommi
- Department of Anesthesiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Jafar Birami
- Laser Application in Medical Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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2
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Yan XJ, Wu B, He X, Tian ZK, Peng BG. Testicular pain originating from lumbar disc degeneration: A case report. World J Clin Cases 2023; 11:1794-1798. [PMID: 36969992 PMCID: PMC10037293 DOI: 10.12998/wjcc.v11.i8.1794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 01/07/2023] [Accepted: 02/15/2023] [Indexed: 03/07/2023] Open
Abstract
BACKGROUND Testicular pain caused by lumbar disease is uncommon in the clinic. Here we reported a case of discogenic low back pain with testicular pain that was successfully cured.
CASE SUMMARY A 23-year-old male patient presented to our department with chronic low back pain. Based on his clinical symptoms, signs and imaging, he was diagnosed with discogenic low back pain. Since conservative treatment for more than half a year did not significantly improve his low back pain, we decided to treat it with intradiscal methylene blue injection. During the course of surgery, we again identified the low back pain as originating from the degenerated lumbar disc by analgesic discography. Interestingly, the patient’s low back pain disappeared along with the testicular pain that had been present for more than 3 mo. After the operation, the patient’s low back pain improved, and the testicular pain did not reappear.
CONCLUSION Intradiscal methylene blue injection is a convenient and effective surgical intervention for the treatment of discogenic low back pain. Lumbar disc degeneration may also be a possible clinical cause of testicular pain. Methylene blue injection in the diseased disc improved the low back pain, and the accompanying testicular pain was successfully managed.
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Affiliation(s)
- Xiu-Jie Yan
- Department of Spine Surgery, The Third Medical Center, PLA (People’s Liberation Army) General Hospital, Beijing 100039, China
| | - Bing Wu
- Department of Spine Surgery, The Third Medical Center, PLA (People’s Liberation Army) General Hospital, Beijing 100039, China
| | - Xin He
- Department of Spine Surgery, The Third Medical Center, PLA (People’s Liberation Army) General Hospital, Beijing 100039, China
| | - Zi-Kai Tian
- Department of Spine Surgery, The Third Medical Center, PLA (People’s Liberation Army) General Hospital, Beijing 100039, China
| | - Bao-Gan Peng
- Department of Spine Surgery, The Third Medical Center, PLA (People’s Liberation Army) General Hospital, Beijing 100039, China
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3
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Banner D, Cassidy D, Appleby C, Dolan S, Freeman S, Klassen-Ross T, Ghag K. Chronic scrotal content pain: the experiences of patients undergoing microsurgical spermatic cord denervation. Ther Adv Urol 2023; 15:17562872231196685. [PMID: 37767052 PMCID: PMC10521267 DOI: 10.1177/17562872231196685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 08/03/2023] [Indexed: 09/29/2023] Open
Abstract
Background Chronic scrotal content pain, sometimes referred to as chronic orchialgia, is a common urological condition that gives rise to persistent and often severe painful stimuli to the scrotum and surrounding structures. Despite its relative commonality, accounting for over 2% of urological visits, chronic scrotal content pain is complex to manage and patients may be required to access multiple providers and undergo invasive procedures, including microsurgical spermatic cord denervation (MSCD) surgery. Objective The objective of this study was to understand the experiences and perspectives of persons with chronic scrotal content pain and accessing MSCD surgery. Design An exploratory qualitative design, guided by interpretive description and integrated knowledge translation, was adopted. Methods We conducted in-depth qualitative interviews with six patients with chronic scrotal content pain who underwent MSCD surgery in a surgical center in Western Canada. Data were analyzed thematically. Results Analysis of the study data resulted in three core themes: living with chronic scrotal content pain, quality of life, and MSCD procedure and outcomes. We highlight the debilitating nature of pain and the broad impacts upon health, quality of life, and social functioning. Participants described how MSCD surgery offered an effective solution for persistent and debilitating pain. For the participants, MSCD surgery offered hope and the chance to regain their normality. Conclusion For those with chronic scrotal content pain, access to a pain specialist, along with the adoption of a biopsychosocial approach to pain and early access to MSCD surgery, may improve patient experiences and outcomes. Considering the high prevalence of urological pain, greater interdisciplinary care is needed in order to support more effective and timely management.
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Affiliation(s)
- Davina Banner
- School of Nursing, University of Northern British Columbia, 3333 University Way, Prince George, BC V2N4Z9, Canada
| | - Darby Cassidy
- Cassidy Urology Clinic, Prince George, BC, Canada (Principal Knowledge-User)
| | - Colin Appleby
- Northern Medical Program, University of Northern British Columbia, Prince George, BC, Canada
| | - Shayna Dolan
- School of Nursing, University of Northern British Columbia, Prince George, BC, Canada
| | - Shannon Freeman
- School of Nursing, University of Northern British Columbia, Prince George, BC, Canada
| | - Tammy Klassen-Ross
- School of Health Sciences, Senior Instructor, University of Northern British Columbia, Prince George, BC, Canada
| | - Kiranpreet Ghag
- School of Nursing, University of Northern British Columbia, Prince George, BC, Canada
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4
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Mamaril-Davis JC, Joshi N, Palsma R, Aguilar-Salinas P, Walter CM, Hashim S, Weinand M. Spinal cord stimulation for genitofemoral neuropathy: A case report and review of the literature. Surg Neurol Int 2022; 13:533. [DOI: 10.25259/sni_901_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 10/13/2022] [Indexed: 11/19/2022] Open
Abstract
Background:
Chronic testicular pain due to genitofemoral neuropathy often becomes refractory to conservative medical therapy. Neurostimulation is a potentially useful treatment option, should the neuropathic pain remain refractory to more invasive procedures such as orchiectomy. We provide a case report of spinal cord stimulation (SCS) for successful treatment of genitofemoral neuropathy and have also reviewed the literature to find similar cases which required a similar treatment paradigm.
Case Description:
A 42-year-old male underwent SCS for refractory testicular and groin pain. SCS through a four-column, 2 × 8 contact neurostimulator paddle lead, was implanted in the mid-thoracic-9 (T9) vertebral level, providing > 50% testicular pain relief with a decrease in visual analog scale scores from 8–10/10 to 3–4/10. The patient required one adjustment to the stimulation parameters at the time of the 6 weeks follow-up visit due to over-stimulation. He then continued to experience >50% resolution in pain 9 months later. A review of the literature yielded only two similar cases that successfully utilized SCS for treatment of chronic testicular pain.
Conclusion:
SCS should be considered as a possible treatment option for patients with chronic testicular pain localized to the genitofemoral nerve distribution.
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Affiliation(s)
| | - Neil Joshi
- Department of Neurosurgery, The University of Arizona College of Medicine - Tucson, Tucson, United States
| | - Ryan Palsma
- Department of Neurosurgery, The University of Arizona College of Medicine - Tucson, Tucson, United States
| | - Pedro Aguilar-Salinas
- Department of Neurosurgery, The University of Arizona College of Medicine - Tucson, Tucson, United States
| | - Christina M. Walter
- Department of Neurosurgery, The University of Arizona College of Medicine - Tucson, Tucson, United States
| | - Shamam Hashim
- Department of Neurosurgery, The University of Arizona College of Medicine - Tucson, Tucson, United States
| | - Martin Weinand
- Department of Neurosurgery, The University of Arizona College of Medicine - Tucson, Tucson, United States
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Chronic scrotal pain: Pathogenesis, clinical phenotypes and modern treatment concept (clinical lecture). ACTA BIOMEDICA SCIENTIFICA 2022. [DOI: 10.29413/abs.2022-7.4.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Chronic scrotal pain (CSP) is a general term, which defines variety of problems causing discomfort or pain in the scrotum, which can be caused by the problems with testicles and other structures of the scrotum: epididymis, vas deferens, paratesticular structures. For a practicing urologist, the diagnosis and treatment of chronic scrotal pain is always a difficult task due to the many reasons for its appearance and the variety of clinical symptoms. CSP is a widespread but poorly understood condition, the etiology of which often can not be identified. Pain localized in the scrotum makes up 38.8 % of all cases of chronic men’s pelvic pain. From 2.5 to 4.8 % of all visits to the urologist relate to CSP syndrome. Primary scrotal pain syndrome is not associated with infection or other local pathological processes that could cause pain. The treatment of chronic scrotal pain is challenging because the pain often does not react to the traditional treatments.The purpose of this lecture is to draw the attention of urologists, general practitioners, and everyone who is interested in the problem of treating chronic scrotal pain to the possibilities of modern medicine in solving this multidisciplinary problem.
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6
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Visser WR, Smith-Harrison L, Payne B, Smith RP, Krzastek SC. Surgical management of chronic scrotal pain: a review of the current literature. Minerva Urol Nephrol 2022; 74:551-558. [PMID: 35274901 DOI: 10.23736/s2724-6051.21.04529-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Chronic scrotal pain may be due to an identifiable cause, may be multifactorial, or may be idiopathic. Successful treatment often requires multimodal therapy with a multidisciplinary approach. Conservative options may be offered initially, but if symptoms fail to improve with conservative interventions, more invasive therapies may be required. A nerve block may be attempted and patients who experience improvement in pain following nerve blocks may be good candidates for surgical denervation of the spermatic cord. Alternative surgical treatment options including proximal nerve blocks, neuromodulation, cryoablation, vasectomy reversal, varicocelectomy, and even orchiectomy have been described. The aim of this review is to discuss the treatment options for chronic scrotal pain with a focus on surgical treatment options.
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Affiliation(s)
- William R Visser
- Division of Urology, Virginia Commonwealth University, Richmond, VA, USA
| | | | - Brayden Payne
- School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Ryan P Smith
- aaaaaaDepartment of Urology, University of Virginia, Charlottesville, VA, USA
| | - Sarah C Krzastek
- Division of Urology, Virginia Commonwealth University, Richmond, VA, USA - .,aaaaaaDepartment of Urology, University of Virginia, Charlottesville, VA, USA.,Division of Urology, Richmond VAMC, Richmond, VA, USA
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7
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Campbell K, Lipshultz L. Current trends and therapies in orchialgia management. Ther Adv Urol 2021; 13:17562872211026433. [PMID: 34221127 PMCID: PMC8221700 DOI: 10.1177/17562872211026433] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 06/01/2021] [Indexed: 11/17/2022] Open
Abstract
The management of pain is a complex condition that will be encountered by most practicing clinicians. In the genitourinary community, testicular pain may be classified as acute or chronic. Initial evaluation of chronic groin and scrotal content pain (CGSCP) begins with a detailed history and physical examination to elucidate the presenting pathology. Multiple therapy algorithms have been proposed with no definitive consensus; however, most begin with conservative intervention and medical management prior to advancing to more invasive procedures. Surgical approaches may range from reconstruction, as in vasovasostomy for post-vasectomy pain syndrome, to excision of the offending agent, as in epididymectomy. This review seeks to focus on chronic pain in the genitourinary community and review techniques of pain management in the current intervention for orchialgia, as well as identify future methods of treatment.
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Affiliation(s)
- Kevin Campbell
- Baylor College of Medicine, Suite 1700, 6624 Fannin, Houston, TX 77030, USA
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8
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Newman DP, Tinkham NH, Sterbis JR, Soto AT. Successful Resolution of Chronic Testicular Pain With an Impairment-Based Treatment Program: A Case Study With One-Year Follow-Up. Cureus 2021; 13:e13850. [PMID: 33859901 PMCID: PMC8038914 DOI: 10.7759/cureus.13850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Chronic testicular pain is a condition commonly experienced by males. Potential causes of testicular pain can be pathology localized within the testicle or referred pain from surrounding tissues or spinal conditions. The diagnostic differential is extensive and can be seen as a diagnosis of exclusion after structural disorders specific to the testicle are ruled out. In approximately 50% of the cases, the cause of pain is undetermined. Patients with testicular and inguinal pain may undergo extensive workup that overlooks potential neuropathic and musculoskeletal causes remote to the testicle. This case study describes the application of a conservative treatment program targeting presumptive chronic genitofemoral and/or ilioinguinal nerve entrapment along the course of the inguinal canal for the treatment of chronic testicular pain. By combining sacroiliac joint osteopathic manipulation, iliopsoas stretching, and soft tissue mobilization utilizing a vacuum suction cup, the patient was symptom-free on the fourth visit after suffering from testicular pain for a year. At a one-year follow-up, the patient remains pain-free.
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Affiliation(s)
- David P Newman
- Pain Management, Tripler Army Medical Center, Honolulu, USA
| | | | | | - Adam T Soto
- Pain Management, Tripler Army Medical Center, Honolulu, USA
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9
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Oh PJ, Bajic P, Lundy SD, Ziegelmann M, Levine LA. Chronic Scrotal Content Pain: a Review of the Literature and Management Schemes. Curr Urol Rep 2021; 22:12. [PMID: 33447905 DOI: 10.1007/s11934-020-01026-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE OF REVIEW Chronic scrotal content pain (CSCP) is a complex condition with multiple etiologies that requires a thorough understanding of its pathophysiology, workup, and treatment options. We performed a comprehensive and contemporary review to augment our current understanding of CSCP. RECENT FINDINGS We discuss new advances in CSCP-specific pain questionnaires, modern studies of microscopic spermatic cord denervation and its variations, and novel techniques including electric nerve stimulation and cryoablation in addition to randomized control trials with significant negative findings. We also present literature focusing on the prevention of CSCP secondary to surgical iatrogenic causes. The constantly evolving literature of CSCP has led to the significant evolution in its diagnosis and treatment, from oral medications to salvage options after microscopic spermatic cord denervation. With each advance, we come closer to developing a more thorough, evidence-based algorithm to guide urologists in treatment of CSCP.
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Affiliation(s)
- Paul J Oh
- Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Ave, Building Q10-1, Cleveland, OH, 44195, USA
| | - Petar Bajic
- Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Ave, Building Q10-1, Cleveland, OH, 44195, USA.
| | - Scott D Lundy
- Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Ave, Building Q10-1, Cleveland, OH, 44195, USA
| | | | - Laurence A Levine
- Division of Urology, Rush University Medical Center, Chicago, IL, USA
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10
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Moubasher A, Waqar M, Raison N, Brunckhorst O, Ahmed K. A Review of the Management of Chronic Scrotal Pain. Cureus 2020; 12:e11979. [PMID: 33312831 PMCID: PMC7725413 DOI: 10.7759/cureus.11979] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2020] [Indexed: 11/30/2022] Open
Abstract
Chronic scrotal pain (CSP) is a common and poorly understood medical condition that significantly affects individuals' quality of life. Many patients seek evaluation and management of their symptoms from multiple physicians. Our review aims to address diagnostic modalities, clinical evaluation, and surgical and non-surgical management. We conducted a computerised detailed search of the PubMed, Medline, Embase and Cochrane databases for reports pertaining to CSP using the Medical Subject Headings keywords 'chronic scrotal pain', 'testicular pain' and 'orchialgia', and we included in the review those that fulfilled the inclusion (adult male with CSP presenting with the criteria of CSP ) and exclusion (extra-scrotal pain) criteria. After the direct causes of CSP were identified by reviewing the clinical evaluations (history taking and examination are mandatory) and the diagnostic evaluations (urine analysis is crucial and ultrasound can be helpful), the most-used medical and non-surgical treatments for CSP were tricyclic antidepressants (success rate of up to 66.6%) and spermatic block (success rate of more than 90%), and the most-used surgical procedure was microsurgical denervation of the spermatic cord (success rate of up to 70%). The evidence currently available remains rare and of low quality, making it difficult to strongly recommend individual treatment options. However, multimodal treatment modalities using physical therapy and psychotherapy may help patients and provide useful tools for coping with this condition. There are also useful non-surgical and surgical options for CSP that depend on the patient's state, the severity of the complaint and what options have already been tried.
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Affiliation(s)
- Amr Moubasher
- Urology, King's College Hospital, London, GBR
- Dermatology and Andrology, Assiut University, Assiut, EGY
| | | | - Nicholas Raison
- Urology, MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, GBR
| | - Oliver Brunckhorst
- Urology, MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, GBR
| | - Kamran Ahmed
- Urology, King's College Hospital, London, GBR
- Urology, MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, GBR
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11
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Prospective control trial: flexible CO 2 laser vs. monopolar electrocautery for robotic microsurgical denervation of the spermatic cord. Int J Impot Res 2020; 32:623-627. [PMID: 32862194 DOI: 10.1038/s41443-020-00352-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 08/13/2020] [Accepted: 08/20/2020] [Indexed: 11/09/2022]
Abstract
Microsurgical denervation of the spermatic cord (MDSC) is a treatment option in patients with chronic orchialgia. This procedure requires precise care to avoid any thermal damage to crucial adjacent tissues (arteries, veins, and lymphatics). Monopolar electrocautery is the standard ligation energy source, but may cause extensive collateral damage to the tissues. However, CO2 laser is known to produce a very predictable tissue penetration and minimal collateral spread. The goal of this study was to compare the extent of collateral thermal damage in both monopolar electrocautery and CO2 laser ablation in the spermatic cord during a robotic assisted MDSC (RMDSC) procedure as well as the feasibility for utilizing the flexible fiber-optic CO2 laser probe after "RMDSC" procedure. RMDSC was performed using standard monopolar electrocautery on the spermatic cord of one side of a fresh human male cadaver (randomly selected) and then compared to RMDSC using the CO2 laser on the contralateral spermatic cord. Nine histological cross-sections from each cord were measured for depth of collateral thermal/cautery injury. The mean collateral thermal injury with CO2 laser was 0.17 ± 0.031 mm (range: 0.15-0.25 mm), and with standard electrocautery 0.72 ± 0.046 mm (range: 0.60-0.75 mm). CO2 laser resulted significantly less collateral thermal injury than standard electrocautery (p < 0.0001). The CO2 laser probe was easy to manipulate with the Black Diamond micro-forceps (Intuitive Surgical, CA) and allowed for convenient tissue plane dissection. Human cadaveric targeted RMDSC using a flexible CO2 laser energy results in significantly decreased collateral thermal injury compared to standard monopolar electrocautery. These initial findings suggest potential advantages of the CO2 laser over traditional monopolar cautery in cases requiring minimal collateral tissue damage. Future studies are needed to assess its clinical potential in microsurgery.
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12
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Reddy AG, Dick BP, Natale C, Akula KP, Yousif A, Hellstrom WJG. Application of Botulinum Neurotoxin in Male Sexual Dysfunction: Where Are We Now? Sex Med Rev 2020; 9:320-330. [PMID: 32641225 DOI: 10.1016/j.sxmr.2020.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 05/11/2020] [Accepted: 05/21/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Botulinum neurotoxin (BoNT) is a recognized therapeutic agent of modern medical care, routinely used to treat medical conditions affecting a variety of organ systems including the musculoskeletal, integumentary, and urological domains. Ongoing research is exploring BoNT's potential role as a therapeutic agent for a variety of male sexual pathologies. OBJECTIVE To review and analyze the literature regarding BoNT as a treatment option for male sexual dysfunction. METHODS A PubMed search was performed for English-language articles in peer-reviewed journals between 1970 and 2019 (with one article from 1897). Relevant articles referenced within these texts were also included. One article did not have an accompanied English full-text available. The following search terms were used: "Botox", "Botulinum toxin", "Botulinum toxin A", "Onabotulinum A", "Abobutlinum A", "BoNT", "BoNT-A", "Male sexual health", "Male sexual pathology", "Peyronie's disease", "Premature ejaculation", "Scrotal Pain", "Penile Retraction", "Scrotox", "Erectile Dysfunction", and "Botox in Urology". RESULTS There is interest in the potential role of BoNT in the treatment of male sexual pathologies. We identified studies that used BoNT to treat chronic scrotal content pain, premature ejaculation, erectile dysfunction, Peyronie's disease, penile retraction, and more. However, despite preclinical/clinical data indicating some potential efficacy and safety in these settings, a lack of robust clinical trial data has resulted in no current Food and Drug Administration-approved indications for the use of BoNT in the treatment of male sexual pathology. As a result, much of the current use of BoNT by today's providers is "off-label," and ongoing clinical trials aim to further elucidate the potential role of this therapeutic agent. CONCLUSION Current data suggest that BoNT could have a potential role as a treatment option for certain types of male sexual pathologies. However, more randomized controlled trial data regarding its long-term safety and efficacy are necessary before a widespread clinical adoption can take place. Reddy AG, Dick BP, Natale C, et al. Application of Botulinum Neurotoxin in Male Sexual Dysfunction: Where Are We Now?. J Sex Med 2021;9:320-330.
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Affiliation(s)
- Amit G Reddy
- Department of Urology, Tulane University School of Medicine, New Orleans, USA
| | - Brian P Dick
- Department of Urology, Tulane University School of Medicine, New Orleans, USA
| | - Caleb Natale
- Department of Urology, Tulane University School of Medicine, New Orleans, USA
| | - Kole P Akula
- Department of Urology, Tulane University School of Medicine, New Orleans, USA
| | - Ayad Yousif
- Department of Urology, Tulane University School of Medicine, New Orleans, USA
| | - Wayne J G Hellstrom
- Department of Urology, Tulane University School of Medicine, New Orleans, USA.
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Aoun F, Malek E, Kazan D, Albisinni S, Peltier A, Bollens R, Roumeguère T. Management of chronic testicular pain due to thoracolumbar junction syndrome: A pilot study. Prog Urol 2020; 30:114-118. [PMID: 31980366 DOI: 10.1016/j.purol.2019.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 12/05/2019] [Accepted: 12/14/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Thoracolumbar dysfunction (TLD) had been evoked as a possible etiology of chronic testicular pain. Our study investigated the efficacy of osteopathic diagnosis and treatment of TLD in men with chronic testicular pain. METHODS Patients suffering from testicular pain were examined for thoracolumbar dysfunction and enrolled in a prospective trial if they have both conditions. Following standardized examination, all patients were prescribed 1 to 3 osteopathic treatment sessions, usually at weekly interval. Treatment success was evaluated using the Visual Analog scale and durability was assessed by regular follow-up. Patient satisfaction was also assessed. Comparison of pain improvement was done using Wilcoxon matched-pairs signed-ranks test. Logistic regression was used to assess for risk factors of success. A P<0.001 was used for significance. RESULT Out of 62 patients enrolled, 41 patients (median age 32 years, IQR 24-37) were suffering from chronic testicular pain and TLD. 37 of the 41 participants completed the treatment and follow-up according to the plan. Patients underwent a median of 2 osteopathic treatment sessions (range 1-3). Overall, pain disappeared completely in 25 patients (67.5%) and improvement was noted in 7 patients (18.9%). After initial improvement, two patients experienced relapse at their last visit (5.4%). Five patients (13.5%) had no improvement of their symptoms after osteopathic treatment. Statistically, improvement was significant with a P<0.001 and on logistic regression, site of pain and duration of pain were the sole predictors of failure. CONCLUSION TLD is a pathology that should be considered in the differential diagnosis in patients with chronic testicular pain and osteopathic manipulation of the spine appears to be an effective treatment option.
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Affiliation(s)
- F Aoun
- Urology department, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Urology department, Hôtel Dieu de France, Université Saint-Joseph, Lebanon.
| | - E Malek
- Osteopathic Medicine department, Levant Hospital, Lebanon
| | - D Kazan
- Urology department, Hôtel Dieu de France, Université Saint-Joseph, Lebanon
| | - S Albisinni
- Urology department, Cliniques Universitaires de Bruxelles, hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - A Peltier
- Urology department, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - R Bollens
- Urology department, Centre Hospitalier de Wallonie picarde, Belgium
| | - T Roumeguère
- Urology department, Cliniques Universitaires de Bruxelles, hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
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Shoskes DA, Calixte N, Tadros N, Li J, Parekattil S. Validation of the Chronic Orchialgia Symptom Index for Men With Chronic Orchialgia/Chronic Scrotal Contents Pain. Urology 2018; 119:39-43. [PMID: 29898380 DOI: 10.1016/j.urology.2018.05.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 04/25/2018] [Accepted: 05/17/2018] [Indexed: 10/14/2022]
Abstract
OBJECTIVE To prospectively validate the chronic orchialgia symptom index (COSI), a newly created instrument with 12 questions in 3 domains (pain, sexual symptoms and quality of life). METHODS The COSI was given to 170 men with chronic orchialgia at 2 institutions. Seventy-eight men repeated the COSI before therapy and 42 repeated it after surgical therapy. Data was analyzed for test/retest internal reliability, internal consistency, floor and ceiling effects, construct validity, responsiveness and linear regression of all questions including age, duration, and prior surgeries. RESULTS The 170 men had a mean age of 44.3 (range 18-82) and median symptom duration of 24 months (3-420). About 22.4% had prior vasectomy, 12.4% had hernia repair, and 12.9% had other prior surgery. Mean total COSI was 20.0±7.7 (range 1-37) with subscores of pain 9.1±3.5 (0-17), sexual symptoms 1.82±1.5 (0-5) and quality of life 9.0±4.0 (0-15). Test/retest reliability was high with mean retest total score of 21.2±7.9 and intraclass correlation coefficient of 0.82. Internal consistency by Cronbach's alpha was 0.86. There were no floor or ceiling effects for total score. Construct validity showed all items contributed to a good fit model (P = .001). Patient age, duration, and prior surgeries did not influence COSI. Finally, the COSI was responsive to improvement after therapy (mean after treatment 13.5±9.8, P = .00001). CONCLUSION COSI is a valid and clinically relevant symptom index to assess severity of orchialgia symptoms and response to therapy in this challenging patient population.
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Affiliation(s)
- Daniel A Shoskes
- Cleveland Clinic, Department of Urology, Glickman Urologic and Kidney Institute, Cleveland, OH.
| | | | - Nick Tadros
- Southern Illinois University, Springfield, IL
| | - Jianbo Li
- Cleveland Clinic, Department of Urology, Glickman Urologic and Kidney Institute, Cleveland, OH
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Polackwich AS, Arora HC, Li J, Levine L, Tojuola B, Parekattil S, Shoskes DA. Development of a clinically relevant symptom index to assess patients with chronic orchialgia/chronic scrotal content pain. Transl Androl Urol 2018; 7:S163-S168. [PMID: 29928613 PMCID: PMC5989111 DOI: 10.21037/tau.2018.04.10] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background The purpose of this study was to develop a candidate symptom index for men with an established diagnosis of chronic orchialgia. Methods Based on interviews with patients and providers, we developed a 70-item questionnaire that focused on seven areas of orchialgia symptoms: pain, location, urinary symptoms, sexual dysfunction, medical history and quality of life (QOL) impact. The questionnaire was completed by patients at two medical centers. Cluster analysis was performed with the software package R (3.2.1). Results A total of 113 men completed the survey. Median symptom duration was 12 months (range, 3-336 months). Outside the testicle, pain was felt in the spermatic cord (66%), groin (66%), penis (24%), suprapubic region (38%), flank (31%), thigh (32%), abdomen (36%) and perineum (35%). Bother scores were high only for testicle and spermatic cord pain. Urinary frequency was common (54%) but not bothersome. Sexual dysfunction was common: 55% had erectile dysfunction, 56% had decreased libido and 39% had painful ejaculation with high bother for all. By cluster analysis, QOL parameters clustered tightly with minimal pain level, pain at night, burning pain, distribution to spermatic cord and groin, erectile dysfunction and premature ejaculation. Conclusions Men with chronic orchialgia have a high incidence of associated symptoms. Most bothersome symptoms with highest QOL impact include burning pain, pain at night, radiation to groin and spermatic cord, erectile dysfunction and low libido. Based on these findings, we have created a candidate orchialgia symptom index with domains of pain, sexual symptoms and QOL that will undergo prospective validation.
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Affiliation(s)
- Alan Scott Polackwich
- Columbia University Department of Urology at Mount Sinai Medical Center, Miami Beach, FL, USA
| | | | - Jianbo Li
- Department of Urology, Cleveland Clinic, Cleveland, OH, USA
| | - Laurence Levine
- Division of Urology, Department of General Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Bayo Tojuola
- The Personalized Urology & Robotics Clinic, Clermont, FL, USA
| | - Sijo Parekattil
- The Personalized Urology & Robotics Clinic, Clermont, FL, USA
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Khyrallh A. Lichtenstein procedure versus darn repair in primary inguinal hernia surgery. AL-AZHAR ASSIUT MEDICAL JOURNAL 2017. [DOI: 10.4103/azmj.azmj_59_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Tan WP, Levine LA. What Can We Do for Chronic Scrotal Content Pain? World J Mens Health 2017; 35:146-155. [PMID: 29282906 PMCID: PMC5746485 DOI: 10.5534/wjmh.17047] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 10/22/2017] [Accepted: 11/12/2017] [Indexed: 11/15/2022] Open
Abstract
Chronic scrotal content pain remains one of the more challenging urological problems to manage. This is a frustrating disorder to diagnose and effectively treat for both the patient and clinician, as no universally accepted treatment guidelines exist. Many patients with this condition end up seeing physicians across many disciplines, further frustrating them. The pathogenesis is not clearly understood, and the treatment ultimately depends on the etiology of the problem. This article reviews the current understanding of chronic scrotal content pain, focusing on the diagnostic work-up and treatment options.
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Affiliation(s)
- Wei Phin Tan
- Department of Urology, Rush University Medical Center, Chicago, IL, USA
| | - Laurence A Levine
- Department of Urology, Rush University Medical Center, Chicago, IL, USA.
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