Testicular Pain: Current Understanding and Treatment
Testicular pain has a significant effect on the quality of life of many men, but it can be successfully treated. There are some anatomic causes that can be identified and treated with proper evaluation including spermatoceles (dilated cysts coming off of the epididymis-the structure between the testicle and vas deferens), tumor, infection, varicoceles (dilated veins around the testicle), and torsion (twisting of the testicle). When there is chronic testicular pain without an identifiable anatomic cause, which is very often the case, there was usually an inciting event such as trauma or infection at some point, which the man may not even remember. In essence, such an initiating event can affect the neurologic system in a way to result in long term pain in the testicle, and it can begin anytime down the road after the inciting event.
When testicular pain is associated with a varicocele, surgically repairing it will result in complete resolution of pain in 70-80% of the time. Another 10-15% of the time the pain will be significantly improved but not completely gone.
When there is not an identifiable source for testicular pain, conservative treatment can be attempted. This can include application of local heat, ice, nerve blocks, and anti-inflammatory medications. When conservative therapy fails or when a more definitive treatment is desired, a microsurgical spermatic cord denervation can be performed. This is a precise microsurgery through a 1-2 inch incision in the groin where the nerves from the testicle that transmit pain are tied off and divided with the assistance of an operative microscope to magnify the nerves. This is a similar approach to repairing a varicocele, except instead of eliminating the effect of the veins in men with varicoceles, the nerves are eliminated in a spermatic cord denervation. There is complete resolution of pain in the testicle in 70-80% of men undergoing spermatic cord denervation and another 10-15% have improvement in the pain.
I perform spermatic cord denervations and varicocelectomies as a day surgery so the man goes home the same day. It is usually about a 45 minute long procedure with a small incision in the groin, made in an area where major strength layers do not have to be opened for an easier recovery. Men are up walking and doing normal activity the day of surgery and are asked to not do any heavy lifting or strenuous activity for about a week. Most men tolerate this extremely well and have very satisfying results overall.