Pain in the testicles is a common and frustrating condition for patients seen and treated by all urologists. There are multiple causes including: infection (orchitis or epididymitis), post surgical pain, trauma, tumors, hernia, varicocele (varicose veins of the testicle), hydrocele or spermatocele. Most of these conditions are easily diagnosed and treated.
Some 25% of men have chronic or intermittent testis pain without any known cause.
Dr. Nudell has seen many patients with all of the above known and unknown causes of testicular pain. For some of these patients it has been a frustrating struggle to find adequate treatments. Dr. Nudell makes sure to listen to tese patients carefully – their pain is not “in their head” as many urologists have told them – he then makes sure all important testing is done including cultures, ultrasound or MRI imaging, and careful serial examinations. Many patients can be managed with conservative medical therapies such as appropriate anti –inflammatories and/or antibiotics. Despite this, some men will need surgery for this condition. Varicocele surgery is done microsurgically to precisely ligate (tie – off) veins of the spermatic cord thorugh a small incision that does not involve any muscles so that healing is rapid and exercise can be rapidly resumed. Spematocele and hydrocele surgery are done similarly.
If pain does not diminish with conservative treatment or directed surgery, Dr. Nudell as a fellowship trained micro – surgeon will consider performing microsurgical denervation of the spermatic cord or “cord stripping.”
This can be done though a small incision (1 inch) in the very low groin. Using the operating microscope, it is possible to separate the sensory nerves from other structures such as veins, nerves and vas deferens. The arteries and lymphatics – the nerves can be divided with all the other structures left in tact. This procedure requires microsurgery to achieve a safe and effective outcome. Complete pain relief can be expected in 75% of appropriately selected patients and partial relief in 90%.