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Post-Laparoendoscopic Single-Site Donor Nephrectomy Ipsilateral Testicular Pain, Does Operative Technique Matter? A Single Center Experience and Review of Literature. Minim Invasive Surg 2022; 2022:3292048. [PMID: 35721390 PMCID: PMC9200591 DOI: 10.1155/2022/3292048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 02/22/2022] [Indexed: 11/17/2022] Open
Abstract
Aim To assess incidence and characteristics of post-laparoendoscopic single-site donor nephrectomy (LESS DN) testicular pain. Materials and Methods A prospective comparative study of all male donors post-left LESS DN (group A) vs. postopen nephrectomies (group B) was performed at our center. Patients' demographics, perioperative data, and postoperative consultation reports were reviewed. Testicular pain, swelling, numbness, urinary symptoms, and sexual dysfunction were evaluated. Patients with a history of scrotal pathology or surgical procedure were excluded. Pain and tenderness were scored on a standard 10-point scale. Results From September 2017 to December 2020, 85 and 35 male patients of groups A and B met the evaluation criteria. Ipsilateral testicular pain developed in 11 patients (15.3%) and 2 patients (9.5%) in groups A and B, respectively. In most instances, the pain was mild to moderate in severity, started after 6 ± 2.1 and 4 ± 1.1 days postoperatively in groups A and B, respectively. Six patients in group A were evaluated with transscrotal ultrasonography that showed no abnormalities. All patients in both groups responded well to medical treatment. Conclusions Post-LESS DN ipsilateral testicular pain is usually mild and self-limited. Preoperative patient education and discussion of the possibility of development of testicular pain and its management should be an integral component of laparoscopic donor nephrectomy informed consent.
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Campo I, Valentino M, Sidhu PS, Magi Meconi L, Van Nieuwenhove S, Cova MA, Derchi LE, Bertolotto M. Nonscrotal Causes of Acute Scrotum. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:597-605. [PMID: 32790121 DOI: 10.1002/jum.15431] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 07/03/2020] [Accepted: 07/05/2020] [Indexed: 06/11/2023]
Abstract
Acute scrotum is characterized by intense acute scrotal pain, which may be associated with other symptoms and signs such as abdominal pain, inflammation, and fever. Many pathologic conditions can present in this way, most which involve the scrotal contents. Nonscrotal conditions, however, can rarely present clinically only as acute scrotum: among them, renal colic, aneurysm rupture or other causes of retroperitoneal hemorrhage, primary abdominal or pelvic tumors and metastases, pancreatitis, pelvic inflammation, and muscle injuries. The pathophysiologic characteristics of the clinical presentation, clues for diagnosis, and imaging features of a series of nonscrotal lesions presenting clinically with acute scrotal pain are herein reported and illustrated. In patients presenting with acute scrotal symptoms and normal scrotal ultrasound findings, nonscrotal causes of acute scrotal pain should be considered in the differential diagnosis. Therefore, an ultrasound investigation of the abdomen, groin, and thighs is indicated.
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Affiliation(s)
- Irene Campo
- Department of Radiology, Ospedale Civile di Conegliano, Conegliano, Italy
| | - Massimo Valentino
- Department of Radiology, Ospedale di Tolmezzo, Azienda Sanitaria Universitaria Friuli Centrale, Tolmezzo, Italy
| | - Paul S Sidhu
- Department of Radiology, King's College Hospital National Health Service Foundation Trust, London, UK
| | - Luca Magi Meconi
- Department of Radiology, University of Trieste, Ospedale di Cattinara, Trieste, Italy
| | | | - Maria Assunta Cova
- Department of Radiology, University of Trieste, Ospedale di Cattinara, Trieste, Italy
| | - Lorenzo E Derchi
- Department of Health Sciences, Radiology Section, University of Genoa, Genoa, Italy
| | - Michele Bertolotto
- Department of Radiology, University of Trieste, Ospedale di Cattinara, Trieste, Italy
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Parekattil SJ, Ergun O, Gudeloglu A. Management of Chronic Orchialgia: Challenges and Solutions - The Current Standard of Care. Res Rep Urol 2020; 12:199-210. [PMID: 32754451 PMCID: PMC7351977 DOI: 10.2147/rru.s198785] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 06/18/2020] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Chronic scrotal content pain (CSP) or chronic orchialgia can be debilitating for patients and difficult to treat. There is a paucity of structured treatment algorithms to approach this difficult condition. METHODS A review of the literature was performed. Conservative treatment options are presented and then targeted surgical interventions that the urologist may perform are then presented in a structured algorithm format. Many of these patients may obtain a significant reduction in pain with some of these treatments. RESULTS This review presents the pathophysiology, a new assessment tool, and various treatment options available for CSP patients, such as targeted spermatic cord blocks, targeted and standard microsurgical denervation of the spermatic cord (77-100% success rates), ultrasound-guided peri-spermatic cord and ilioinguinal cryoablation (59-75% success rates), scrotox (botox) (56-72% success rates), targeted ilioinguinal and iliohypogastric peripheral nerve stimulation (72% success rate), radical orchiectomy (20-75% success rate), targeted robotic-assisted intra-abdominal denervation (71% success rate) and vasectomy reversal (69-100% success rates). CONCLUSION A structured and evidence-based approach to help urologists manage patients with chronic orchialgia or scrotal content pain is presented.
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Affiliation(s)
| | - Onuralp Ergun
- Department of Urology, Hacettepe University, Ankara, Turkey
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Pinar U, Pettenati C, Hurel S, Pietak M, Dariane C, Audenet F, Legendre C, Rozenberg A, Méjean A, Timsit MO. Persistent orchialgia after laparoscopic living-donor nephrectomy: an underestimated complication requiring information adjustment. World J Urol 2020; 39:621-627. [PMID: 32363451 DOI: 10.1007/s00345-020-03228-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 04/24/2020] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Laparoscopic living-donor nephrectomy (LLDN) is the gold-standard procedure for kidney procurement. Ipsilateral orchialgia has barely been described. Some authors reported that ligation of gonadal vein (GV) above iliac vessel bifurcation could prevent orchialgia. We aimed to assess incidence and duration of orchialgia after LLDN in male donors despite distal ligation of GV. METHODS Patients who underwent LLDN from 2014 to 2017 were included. Standard procedure consisted in distal ligation of GV, close to the renal vein confluence and proximal ureteral ligation. Patients' demographics, per-operative data, and post-operative consultation reports were retrospectively reviewed. Orchialgia and scrotal symptoms were assessed through a non-validated questionnaire by phone interview. RESULTS Sixty-nine donors were included. Orchialgia incidence and testicular swelling were 31.9% (n = 22) and 15.9% (n = 11), respectively. Median symptom duration was 15.5 months. Orchialgia led to medical consultation in 41.7% (n = 10) of cases. All patients declared having been informed, prior to donation, about possible residual pain but not specifically orchialgia. CONCLUSION Orchialgia after LLDN affects more than 30% of donors, despite distal ligation of GV and led less than 50% of them to medical consultation, suggesting a large underestimation in clinical practice. Emphasis should be put on this complication during pre-donation information.
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Affiliation(s)
- Ugo Pinar
- Department of Urology and Renal Transplantation, Hôpital Européen Georges Pompidou, AP-HP, 20 rue Leblanc, 75015, Paris, France. .,Université de Paris, APHP Centre, Paris, France.
| | - Caroline Pettenati
- Department of Urology and Renal Transplantation, Hôpital Européen Georges Pompidou, AP-HP, 20 rue Leblanc, 75015, Paris, France.,Université de Paris, APHP Centre, Paris, France
| | - Sophie Hurel
- Department of Urology and Renal Transplantation, Hôpital Européen Georges Pompidou, AP-HP, 20 rue Leblanc, 75015, Paris, France.,Université de Paris, APHP Centre, Paris, France
| | - Michel Pietak
- Department of Urology and Renal Transplantation, Hôpital Européen Georges Pompidou, AP-HP, 20 rue Leblanc, 75015, Paris, France.,Université de Paris, APHP Centre, Paris, France
| | - Charles Dariane
- Department of Urology and Renal Transplantation, Hôpital Européen Georges Pompidou, AP-HP, 20 rue Leblanc, 75015, Paris, France.,Université de Paris, APHP Centre, Paris, France
| | - François Audenet
- Department of Urology and Renal Transplantation, Hôpital Européen Georges Pompidou, AP-HP, 20 rue Leblanc, 75015, Paris, France.,Université de Paris, APHP Centre, Paris, France
| | - Christophe Legendre
- Université de Paris, APHP Centre, Paris, France.,Department of Nephrology and Renal Transplantation, Hôpital Necker-Enfants malades, AP-HP, 149 rue de Sèvres, 75015, Paris, France
| | - Alain Rozenberg
- Université de Paris, APHP Centre, Paris, France.,Department of Anaesthesiology, Hôpital Necker-Enfants malades, AP-HP, 149 rue de Sèvres, 75015, Paris, France
| | - Arnaud Méjean
- Department of Urology and Renal Transplantation, Hôpital Européen Georges Pompidou, AP-HP, 20 rue Leblanc, 75015, Paris, France.,Université de Paris, APHP Centre, Paris, France
| | - Marc-Olivier Timsit
- Department of Urology and Renal Transplantation, Hôpital Européen Georges Pompidou, AP-HP, 20 rue Leblanc, 75015, Paris, France.,Université de Paris, APHP Centre, Paris, France
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Sureka SK, Srivastava A, Agarwal S, Srivastava A, An S, Singh S, Mittal V, Patidar N, Kapoor R, Ansari MS. Prevention of Orchialgia After Left-Sided Laparoscopic Donor Nephrectomy-A Prospective Study. J Endourol 2015; 29:696-9. [PMID: 25401724 DOI: 10.1089/end.2014.0645] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND PURPOSE Etiology of orchialgia or testicular pain after laparoscopic donor nephrectomy (LDN) has been found to be related to injury of the spermatic plexus during gonadal (testicular) vein (GV) or ureteral ligation. This study aimed to evaluate and validate the impact of the level of ligation of GV and ureter in relation to the crossing of iliac vessels (CIV) on incidence of orchialgia. PATIENTS AND METHODS A prospective study was conducted on 70 males who underwent left LDN from January 2008 to December 2010 (group A) to determine the correlation between orchialgia and level of ligation of the GV and ureter with respect to CIV; this revealed that the ligation of the GV and/or ureter above the level of the CIV (level 1, n=40) is less likely to cause orchialgia than ligating them at or below (level 2, n=30). Subsequently, in 45 male patients (group B) for left LDN from January 2011 to June 2013, we ensured that clipping of the ureter and GV be performed above the CIV to validate the above findings. Patients with a history of scrotal pathology or surgical procedure were excluded. One-sided Z-test with pooled variance was used to calculate the sample size. RESULTS In group A, orchialgia was seen in 10 (14.3%) patients. The clipping of the ureter and GV at level 2 (orchialgia, n=9) was associated with a significantly higher incidence of orchialgia than clipping them at level 1 (orchialgia, n=1) (P=0.001,95% confidence interval=0.0707 to 0.2471). In group B, 43 patients were finally analyzed, and none had orchialgia. CONCLUSION The level of ligation of the GV and ureter has significant impact on the incidence of orchialgia. Ipsilateral testicular pain in patients with left-sided LDN is preventable, if the ureter and GV are ligated or clipped above the level of iliac vessels bifurcation.
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Affiliation(s)
- Sanjoy Kumar Sureka
- Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences , Lucknow, India
| | - Aneesh Srivastava
- Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences , Lucknow, India
| | - Shikhar Agarwal
- Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences , Lucknow, India
| | - Alok Srivastava
- Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences , Lucknow, India
| | - Sachin An
- Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences , Lucknow, India
| | - Sanjeet Singh
- Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences , Lucknow, India
| | - Varun Mittal
- Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences , Lucknow, India
| | - Nitesh Patidar
- Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences , Lucknow, India
| | - Rakesh Kapoor
- Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences , Lucknow, India
| | - M S Ansari
- Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences , Lucknow, India
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Jalali M, Rahmani S, Joyce AD, Cartledge JJ, Lewis MH, Ahmad N. Laparoscopic donor nephrectomy: an increasingly common cause for testicular pain and swelling. Ann R Coll Surg Engl 2012; 94:407-10. [PMID: 22943330 PMCID: PMC3954321 DOI: 10.1308/003588412x13171221592177] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Laparoscopic donor nephrectomy (LDN) is now a well established method for kidney procurement from living donors. In our centre, LDN is currently offered only to donors suitable for a left nephrectomy. The aim of this study was to investigate the incidence of testicular pain and swelling following LDN. METHODS A total of 25 left-sided LDN male patients were assessed in a prospective structured interview together with a control cohort of 25 male patients who had undergone left-sided open donor nephrectomy (ODN). RESULTS Data were collected on testicular pain, swelling, numbness, urinary symptoms and sexual dysfunction from all 50 patients (100% response rate). Of the 25 LDN patients, 11 (44%) experienced ipsilateral testicular pain and/or swelling. In most instances, pain was of immediate onset, mild to moderate in severity, lasted for a few days to several weeks and was associated with testicular swelling (10 of 11 cases). However, testicular pain and/or swelling were not apparent in ODN patients, with only 2 of 25 (8%) experiencing mild testicular pain, 1 of whom also had swelling. CONCLUSIONS Testicular pain and swelling following LDN is a common problem. It is underreported in the literature and should be included in the differential diagnoses of testicular pain and swelling. Further investigation is required to confirm our findings.
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Affiliation(s)
- M Jalali
- Leeds Teaching Hospitals NHS Trust, UK
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Srivastava A, Kapoor R, Srivastava A, Ansari MS, Singh M, Kapoor R. Orchialgia after laproscopic renal surgery: a common problem with questionable etiology. Are there any predictors? World J Urol 2012; 31:1153-7. [PMID: 22527670 DOI: 10.1007/s00345-012-0864-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Accepted: 03/28/2012] [Indexed: 10/28/2022] Open
Abstract
PURPOSE Orchialgia after laproscopic renal surgery has been rarely reported in literature, and gonadal vein ligation is considered the main etiology. Our objective was to study the incidence, intensity and to find out any specific factors that could lead to orchialgia. MATERIALS AND METHODS All patients planned for laproscopic renal surgery between Jan 2009 and July 2011 had a history and physical examination before surgery, in postoperative period, and after discharge. Pain was scored on a standard 10-point scale approved by the NIH. Baseline, perioperative, and postoperative data were collected prospectively. RESULTS A total of 460 laproscopic renal surgeries were performed on males out of which 440 met our criteria of evaluation. A total of 38 patients had ipsilateral orchialgia (8.52 %). The pain was more common for left-sided procedures. Mean pain intensity was 3.2. On statistical analysis, there was no difference in the operative parameters between patients of pain and those without pain except that the level of ligation of ureter and that of gonadal vein were significantly associated with orchialgia (p value <0.001 and 0.003, respectively) with the odds ratio for ligating them below the crossing of iliac vessels being 6.443 (3.098-13.397) and 4.457 (2.165-9.176), respectively. CONCLUSION Ipsilateral orchialgia is common in patients undergoing laproscopic renal surgery specially after radical nephroureterectomy and nephrectomy specially when the ureter and gonadal vein are taken down at or below their crossing of iliac vessels. Taking down ureter above, rather than below, the iliac vessels whenever possible may be preventive as is the preservation of gonadal vein.
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Affiliation(s)
- Alok Srivastava
- Department of Urology and Renal Transplant, SGPGIMS, Lucknow, India,
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Shirodkar SP, Gorin MA, Sageshima J, Bird VG, Martinez JM, Zarak A, Guerra G, Chen L, Burke GW, Ciancio G. Technical modification for laparoscopic donor nephrectomy to minimize testicular pain: a complication with significant morbidity. Am J Transplant 2011; 11:1031-4. [PMID: 21521470 DOI: 10.1111/j.1600-6143.2011.03495.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The laparoscopic approach to donor nephrectomy is becoming increasingly common. While it is felt that the recovery from laparoscopic nephrectomy is quicker and less painful, a number of complications have been reported. A rarely reported on complication in the literature with significant morbidity is ipsilateral orchalgia. From 1998 to 2008, 257 hand-assisted laparoscopic donor nephrectomies were performed at our institution. Eight of 129 (6.2%) men complained of de novo ipsilateral orchalgia postoperatively. The average duration of pain was 402 days. Patients reported significant morbidity related to this complication. None, however, required further treatment. Three patients reported that they would reconsider organ donation as a result of testicular pain. Our technique originally included dissection and ligation of the gonadal vein en bloc with the ureter at the level of the left common iliac artery. Since recognizing this complication, we have adopted a gonadal vein sparing approach so as not to disturb the vessel below its point of ligation at the renal vein. To date, 50 patients have undergone the modified technique without experiencing orchalgia. In conclusion, ipsilateral testicular pan is a relatively frequent complication of laparoscopic donor nephrectomy and may be a source of significant morbidity. Using a modified surgical technique, this complication can be reduced or eradicated.
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Affiliation(s)
- S P Shirodkar
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA
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Klotz A, Moormann O. [Special pain conditions in urology. Summary, literature review and suggestions]. Urologe A 2009; 48:1170, 1172-4. [PMID: 19777203 DOI: 10.1007/s00120-009-2037-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The diagnosis of acute or chronic pain syndromes of the urogenital system can be verified and successfully treated by exact exploration of the patients medical history, the physical examination and a few image-guided or laboratory analyses Pain conditions which remain of unknown etiology even after extensive investigations are difficult to treat by the urologist alone. In cases where no causally determined morphological changes can be found or the alteration is disproportionate to the discomfort sensed by the patient, a multidisciplinary therapy strategy offers an approach to find a solution.
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Affiliation(s)
- A Klotz
- Paracelsus-Klinik Golzheim, Düsseldorf.
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