BACKGROUND Approximately 25% to 50% of Chronic Orchialgia is not known to have a specific etiology and is referred to as Idiopathic Chronic Orchialgia (ICO). The evaluation and treatment of this diagnosis can be challenging for physicians given that pathophysiology is not entirely understood. Management algorithms suggest progression to spermatic cord block if conservative management fails. We aimed to better understand the predictive factors of patients who present with ICO and have a response to spermatic cord block (SCB).
METHODS We conducted a retrospective chart review of all male patients presenting to our men’s health urologic clinic with scrotal pain between January 2016-June 2022. 350 patients were reviewed and 88 were determined to qualify as having true ICO without otherwise identifiable cause for their pain. Patients were stratified by having successful or unsuccessful SCB response. They were matched 2 to 1 by age. Chi-Square Test and T-test were run for statistical analysis and a p<0.05 was considered statistically significant. RESULTS A total of 26 patients who had a SCB were responsive to it and 26 were not, after matching for age. Mean duration of pain in those who responded to SCB was about 7 months longer than those who did not respond (p=0.060). Neither the Likert Pain Score nor the Chronic Orchialgia Index Score showed a significant difference between those who responded to SCB and those who did not. In those who responded to SCB, 60% described their pain as constant compared to 37% of those who did not respond to SCB (p=0.025). Only 14% of patients who did not respond to SCB responded to neuromodulating medications while 55% of patients who responded to SCB also responded to these medications. Table 1 summarizes other potential predictive factors for those who respond to SCB for management of their ICO, most not showing a significant difference between cohorts.
CONCLUSION These findings suggest that when evaluating patients for a SCB for the successful management of their ICO, it is important to understand the characteristics of their pain as well as the previous treatment methods that proved effective.
Table 1: Predictive Factors and Response to Spermatic Cord Block
| Responded to SCBN=26(%) | No Response to SCBN=26(%) | X2 | p-value | |||
| PainCharacteristics | Intermittent | 10(38.5) | 12(46.2) | 0.32 | 0.5745 | |
| Constant | 15(57.7) | 7(26.9) | 5.04 | 0.0247 | ||
| Radiates | 12(46.2) | 16(61.5) | 1.24 | 0.2658 | ||
| Dull | 10(38.5) | 6(23.1) | 1.44 | 0.2294 | ||
| Achy | 7(26.9) | 4(15.4) | 1.04 | 0.3084 | ||
| Sharp/Stabbing | 12(46.2) | 6(23.1) | 3.06 | 0.0803 | ||
| Othe Symptoms | 7(26.9) | 7(26.9) | 0.00 | 1.000 | ||
| Medical History | History of Vasectomy | 7(26.9) | 8(30.7) | 0.09 | 0.7595 | |
| Other UrologicalCondition | 14(53.8) | 13(50.0) | 0.08 | 0.7814 | ||
| Social History | Alcohol Use at First Encounter | 12*(60.0) | 13**(59.1) | 0.004 | 0.9522 | |
| Tobacco Use at First Encounter | 5(19.2) | 5***(20.0) | 0.005 | 0.9449 | ||
| Physical Exam | Tenderness to Palpation | 16(61.5) | 20(76.9) | 1.44 | 0.2294 | |
| Response to Previous Management | Conservative Measurements | 3+(21.4) | 2++(16.7) | 0.09 | 0.7587 | |
| Oral Neuromodulating Pain Medications | 6+++(54.5) | 2+(14.3) | 4.59 | 0.0322 | ||
