Progres en urologie : journal de l'Association francaise d'urologie et de la Societe francaise d'urologie · 2010
[Therapeutic management of chronic intrascrotal pain].
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Sibert L, Rigaud J, Delavierre D, Labat J-J
Аннотация
OBJECTIVE: To resume available therapeutic options for intra scrotal chronic pain, including surgical procedures, and to analyze their efficiency through a review of published data.
MATERIAL AND METHODS: Review of articles published on this topic in the Medline (PubMed) database, selected according to their scientific relevance.
RESULTS: Initial treatment of epididydimal and testicular pain should always be conservative. Mean success rates of the different therapeutic options varies from 27% to 90%. Surgery on the scrotal content should be considered only if: (1) Pain can be explained by a local intra scrotal cause; (2) Medical and conservative treatments have failed; (3) Nerve block has been tried and is efficient in relieving pain; (4) Patients are informed of the risk of failure. Conservative surgical procedure (epididymectomy, vasovasostomy) have a success rate of 50-70%. Microsurgical spermatic cord denervation yields better results, while preserving testis and epididymis integrity. Failure is still possible (15%). Orchidectomy should be avoided if possible.
CONCLUSIONS: Levels of evidence concerning indications and efficiency of these surgical procedures are low. Patients suffering from recurring or implacable chronic testicular and epididymal pain require a multidisciplinary care.
MATERIAL AND METHODS: Review of articles published on this topic in the Medline (PubMed) database, selected according to their scientific relevance.
RESULTS: Initial treatment of epididydimal and testicular pain should always be conservative. Mean success rates of the different therapeutic options varies from 27% to 90%. Surgery on the scrotal content should be considered only if: (1) Pain can be explained by a local intra scrotal cause; (2) Medical and conservative treatments have failed; (3) Nerve block has been tried and is efficient in relieving pain; (4) Patients are informed of the risk of failure. Conservative surgical procedure (epididymectomy, vasovasostomy) have a success rate of 50-70%. Microsurgical spermatic cord denervation yields better results, while preserving testis and epididymis integrity. Failure is still possible (15%). Orchidectomy should be avoided if possible.
CONCLUSIONS: Levels of evidence concerning indications and efficiency of these surgical procedures are low. Patients suffering from recurring or implacable chronic testicular and epididymal pain require a multidisciplinary care.