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 surgical management if the spermatic cord block is at least 50% successful. We analyzed predictors of patient progression to successful surgical management of this condition. 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 surgery with good response or not progressing to surgery. 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 22 patients progressed to successful and responsive surgical management to their pain while 44 did not, after matching. Patients who went on to have successful surgery had an average duration of pain that was 53 months longer than those who did not (p=0.0232). Neither the Likert Pain Score nor Chronic Orchialgia Symptom Index Score showed a significant difference between the cohorts. 15% of patients who did not undergo surgery described their pain as “achy” as compared to 9% of those in the patients who progressed to surgery (p=.03). In those who did not progress to surgery, 71% had a response to oral neuromodulating pain medications, as opposed to the 14.3% who had a response to these medication and progressed to successful surgery. Table 1 summarizes other potential predictive factors for those who progress to successful and responsive surgical management of ICO, most not showing a significant difference between cohorts.
CONCLUSION Duration of pain, characteristics of pain, and response to neuromodulating oral pain mediations can help provide insight of whether a patient with ICO will progress to surgical management and if they will be responsive to it.
Table 1: Predictive Factors and Progression to Successful Surgical Management of Idiopathic Chronic Orchialgia
| Progressed to Successful SurgeryN=22(%) | No Surgery ProgressionN=44(%) | X2 | p-value | |||
| PainCharacteristics | Intermittent | 11(50.0) | 25(56.8) | 0.28 | 0.6000 | |
| Constant | 9(40.9) | 13(29.5) | 0.85 | 0.3559 | ||
| Radiates | 9(40.9) | 26(59.1) | 1.94 | 0.1630 | ||
| Dull | 5(22.7) | 16(36.4) | 1.26 | 0.2622 | ||
| Achy | 2(9.1) | 15(34.1) | 4.79 | 0.0287 | ||
| Sharp/Stabbing | 8(36.4) | 11(25.0) | 0.92 | 0.3365 | ||
| Other Symptoms | 3(13.6) | 12(27.3) | 1.55 | 0.2127 | ||
| Medical History | Other UrologicalCondition | 12(54.5) | 19(43.2) | 0.76 | 0.3832 | |
| Social History | Alcohol Use | 10*(52.6) | 23**(69.7) | 1.51 | 0.2185 | |
| Tobacco Use | 5(22.7) | 6(13.6) | 0.87 | 0.3502 | ||
| Physical Exam | Tenderness to Palpation | 17(77.3) | 29(65.9) | 0.90 | 0.3437 | |
| Response to Previous Management | Oral Neuromodulating Pain Medications | 2***(14.3) | 5+(71.4) | 6.86 | 0.0088 | |
| Response to Previous SCB | 9++(45.0) | 10+++(47.6) | 0.03 | 0.8665 |
