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Schiellerup NS, Kobberø H, Andersen K, Poulsen CA, Poulsen MH. Evaluation of Botox treatment in patients with chronic scrotal pain: Protocol for a randomized double-blinded control trial. BJUI COMPASS 2024; 5:541-547. [PMID: 38873349 PMCID: PMC11168772 DOI: 10.1002/bco2.349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 12/27/2023] [Accepted: 01/21/2024] [Indexed: 06/15/2024] Open
Abstract
Background Chronic scrotal pain is a common condition with a prevalence of 2.5-4.8% in male outpatients. Up to 40% of these patients report depressive symptoms and many feel isolated. Minimal invasive treatment is lacking, while spermatic cord injections of Botox® (BTX) have been proposed to offer long-term pain relief. Study Design This research protocol comprises a prospective multicentre, randomized, double-blinded clinical trial drawing patients from other urological departments in the region of Southern Denmark. End Points The primary end point will be reduction in pain evaluated by visual analogue score for pain at 3 months. Secondary end point will be length of effect of BTX injections along with changes in quality of life. Patients and Methods The study will include 50 patients for randomization to either spermatic cord block with 100 IE BTX or sterile saline. All patients will prior to randomization undergo physical examination and will be asked to fulfil multiple questionnaires regarding pain and impact in daily life, that is, (1) visual analogue score for pain, (2) quality of life (EQ-5D-5L), (3) Chronic Prostatitis Symptom Index (NIH-CPSI), (4) ICD-10 depression questionnaire (MDI), (5) Likert global assessment scale, and (6) International Index of Erectile Function questionnaire. Physical examination and fulfilment of the questionnaires will be repeated multiple times throughout the study period of 12 weeks. After this time point, patients will be unblinded, and the control arm will be given the opportunity of cross-over.
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Affiliation(s)
| | - Hanne Kobberø
- Department of UrologyOdense University HospitalOdenseDenmark
| | - Karin Andersen
- Department of UrologyOdense University HospitalOdenseDenmark
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Banner D, Cassidy D, Appleby C, Dolan S, Freeman S, Klassen-Ross T, Ghag K. Chronic scrotal content pain: the experiences of patients undergoing microsurgical spermatic cord denervation. Ther Adv Urol 2023; 15:17562872231196685. [PMID: 37767052 PMCID: PMC10521267 DOI: 10.1177/17562872231196685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 08/03/2023] [Indexed: 09/29/2023] Open
Abstract
Background Chronic scrotal content pain, sometimes referred to as chronic orchialgia, is a common urological condition that gives rise to persistent and often severe painful stimuli to the scrotum and surrounding structures. Despite its relative commonality, accounting for over 2% of urological visits, chronic scrotal content pain is complex to manage and patients may be required to access multiple providers and undergo invasive procedures, including microsurgical spermatic cord denervation (MSCD) surgery. Objective The objective of this study was to understand the experiences and perspectives of persons with chronic scrotal content pain and accessing MSCD surgery. Design An exploratory qualitative design, guided by interpretive description and integrated knowledge translation, was adopted. Methods We conducted in-depth qualitative interviews with six patients with chronic scrotal content pain who underwent MSCD surgery in a surgical center in Western Canada. Data were analyzed thematically. Results Analysis of the study data resulted in three core themes: living with chronic scrotal content pain, quality of life, and MSCD procedure and outcomes. We highlight the debilitating nature of pain and the broad impacts upon health, quality of life, and social functioning. Participants described how MSCD surgery offered an effective solution for persistent and debilitating pain. For the participants, MSCD surgery offered hope and the chance to regain their normality. Conclusion For those with chronic scrotal content pain, access to a pain specialist, along with the adoption of a biopsychosocial approach to pain and early access to MSCD surgery, may improve patient experiences and outcomes. Considering the high prevalence of urological pain, greater interdisciplinary care is needed in order to support more effective and timely management.
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Affiliation(s)
- Davina Banner
- School of Nursing, University of Northern British Columbia, 3333 University Way, Prince George, BC V2N4Z9, Canada
| | - Darby Cassidy
- Cassidy Urology Clinic, Prince George, BC, Canada (Principal Knowledge-User)
| | - Colin Appleby
- Northern Medical Program, University of Northern British Columbia, Prince George, BC, Canada
| | - Shayna Dolan
- School of Nursing, University of Northern British Columbia, Prince George, BC, Canada
| | - Shannon Freeman
- School of Nursing, University of Northern British Columbia, Prince George, BC, Canada
| | - Tammy Klassen-Ross
- School of Health Sciences, Senior Instructor, University of Northern British Columbia, Prince George, BC, Canada
| | - Kiranpreet Ghag
- School of Nursing, University of Northern British Columbia, Prince George, BC, Canada
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Rourke D, Bekkema J, Rourke KF. Prospective Assessment of Genital Pain in Patients With Urethral Stricture: Incidence, Associations, and Impact of Urethroplasty. Urology 2023; 171:221-226. [PMID: 36343864 DOI: 10.1016/j.urology.2022.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/06/2022] [Accepted: 10/09/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To assess the incidence of genital pain in patients with urethral stricture and examine the impact of urethroplasty. Genital pain is a common and challenging urological condition and potentially associated with urethral stricture. METHODS From 2011-2019, patients were offered enrollment in a prospective single-center study assessing patient-reported genital pain pre- and 6-months posturethroplasty. Genital pain was assessed with the question, "Do you experience genital (scrotum or penis) pain?" answered on a five-point scale ["Never" (1), "Occasionally" (2), "Sometimes" (3), "Most of the Time" (4) or "All of the Time" (5)]. Responses of 3, 4, or 5 were considered clinically significant. Wilcoxon signed-rank test was used to compare pre- and postoperative states and logistic regression was used to evaluate the association between genital pain and clinical variables. RESULTS Of the 387 patients completing enrollment, 36.4% (141/387) reported genital pain preoperatively. Patients with panurethral stricture reported higher rates (57.1%) of pain (Odds Ratio 2.93, 95%CI 1.32-6.50; P = .008). Posturethroplasty, pain scores improved with an incidence of 14.2% (P < .0001). In patients reporting preoperative pain, 88.7% (125/141) experienced improvement, 8.5% were unchanged and 2.8% reported worsening pain. On logistic regression, patients with penile strictures (O.R. 0.24, 95%CI 0.06-0.91; P = .04), hypospadias (O.R. 0.14, 95%CI 0.02-0.88; P = .04), and staged reconstruction (O.R. 0.22, 95%CI 0.05-0.90; P = .04) were less likely to report improvement. CONCLUSION Genital pain is common in patients with urethral stricture and improves in the majority of patients undergoing urethroplasty but less so in patients with penile strictures, hypospadias and staged reconstruction.
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Affiliation(s)
- Declan Rourke
- Department of Biological Sciences, University of Alberta, Edmonton, AB, Canada
| | - Jordan Bekkema
- Division of Urology, University of Alberta, Edmonton, AB, Canada
| | - Keith F Rourke
- Division of Urology, University of Alberta, Edmonton, AB, Canada.
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Alzahrani MA, Safar O, Almurayyi M, Alahmadi A, Alahmadi AM, Aljohani M, Almhmd AE, Almujel KN, Alyousef B, Bashraheel H, Badriq F, Almujaydil A. Pulsed Radiofrequency Ablation for Orchialgia-A Literature Review. Diagnostics (Basel) 2022; 12:diagnostics12122965. [PMID: 36552972 PMCID: PMC9777127 DOI: 10.3390/diagnostics12122965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 11/22/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022] Open
Abstract
Pulsed radiofrequency, short bursts of radiofrequency energy, has been used by pain practitioners as a non- or minimally neurodestructive technique, an alternative to radiofrequency heat lesions. The clinical advantages and mechanisms of this treatment remain unclear. To review the current clinical implication of the pulsed radiofrequency technique for male patients with chronic scrotal pain. We systematically searched the English literature available at the EMBASE, MEDLINE/PubMed, Google Scholar, and Cochrane Library from inception to 22 November 2022. Only reports on a pulsed radiofrequency application on male patients with chronic scrotal pain were included. The final analysis yielded six reports on the clinical use of pulsed radiofrequency applications in male patients with chronic scrotal pain: six full publications, three case reports, one case series, one prospective uncontrolled pilot study, and one prospective randomized, controlled clinical trial. The accumulation of these data shows that using pulsed radiofrequency generates an increasing interest in pain physicians, radiologists, and urologists for managing chronic scrotal pain. No side effects related to the pulsed radiofrequency technique were reported to date. Further research on the clinical and biological effects is justified. Large sample sizes and randomized clinical trials are warranted.
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Affiliation(s)
- Meshari A. Alzahrani
- Department of Urology, College of Medicine, Majmaah University, Al-Majmaah 11952, Saudi Arabia
- Correspondence: ; Tel.: +966-569990693; Fax: +966-164042500
| | - Omar Safar
- Urology Department, Armed Forces Hospital Southern Region, Khamis Mushayt 62461, Saudi Arabia
| | - Muath Almurayyi
- Urology Department, King Khaled University Medical City, Abha 62529, Saudi Arabia
| | | | | | | | - Abdalah E. Almhmd
- College of Medicine, Majmaah University, Al-Majmaah 11952, Saudi Arabia
| | | | - Bader Alyousef
- College of Medicine, The Royal College of Surgeons in Ireland, D02 YN77 Dublin, Ireland
| | - Hussam Bashraheel
- Department of Urology, King Fahad General Hospital, Jeddah 23325, Saudi Arabia
| | - Feras Badriq
- Division of Urology, Department of Surgery, East Jeddah General Hospital, Jeddah 22253, Saudi Arabia
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Visser WR, Smith-Harrison L, Payne B, Smith RP, Krzastek SC. Surgical management of chronic scrotal pain: a review of the current literature. Minerva Urol Nephrol 2022; 74:551-558. [PMID: 35274901 DOI: 10.23736/s2724-6051.21.04529-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Chronic scrotal pain may be due to an identifiable cause, may be multifactorial, or may be idiopathic. Successful treatment often requires multimodal therapy with a multidisciplinary approach. Conservative options may be offered initially, but if symptoms fail to improve with conservative interventions, more invasive therapies may be required. A nerve block may be attempted and patients who experience improvement in pain following nerve blocks may be good candidates for surgical denervation of the spermatic cord. Alternative surgical treatment options including proximal nerve blocks, neuromodulation, cryoablation, vasectomy reversal, varicocelectomy, and even orchiectomy have been described. The aim of this review is to discuss the treatment options for chronic scrotal pain with a focus on surgical treatment options.
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Affiliation(s)
- William R Visser
- Division of Urology, Virginia Commonwealth University, Richmond, VA, USA
| | | | - Brayden Payne
- School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Ryan P Smith
- aaaaaaDepartment of Urology, University of Virginia, Charlottesville, VA, USA
| | - Sarah C Krzastek
- Division of Urology, Virginia Commonwealth University, Richmond, VA, USA - .,aaaaaaDepartment of Urology, University of Virginia, Charlottesville, VA, USA.,Division of Urology, Richmond VAMC, Richmond, VA, USA
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Moubasher A, Waqar M, Raison N, Brunckhorst O, Ahmed K. A Review of the Management of Chronic Scrotal Pain. Cureus 2020; 12:e11979. [PMID: 33312831 PMCID: PMC7725413 DOI: 10.7759/cureus.11979] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2020] [Indexed: 11/30/2022] Open
Abstract
Chronic scrotal pain (CSP) is a common and poorly understood medical condition that significantly affects individuals' quality of life. Many patients seek evaluation and management of their symptoms from multiple physicians. Our review aims to address diagnostic modalities, clinical evaluation, and surgical and non-surgical management. We conducted a computerised detailed search of the PubMed, Medline, Embase and Cochrane databases for reports pertaining to CSP using the Medical Subject Headings keywords 'chronic scrotal pain', 'testicular pain' and 'orchialgia', and we included in the review those that fulfilled the inclusion (adult male with CSP presenting with the criteria of CSP ) and exclusion (extra-scrotal pain) criteria. After the direct causes of CSP were identified by reviewing the clinical evaluations (history taking and examination are mandatory) and the diagnostic evaluations (urine analysis is crucial and ultrasound can be helpful), the most-used medical and non-surgical treatments for CSP were tricyclic antidepressants (success rate of up to 66.6%) and spermatic block (success rate of more than 90%), and the most-used surgical procedure was microsurgical denervation of the spermatic cord (success rate of up to 70%). The evidence currently available remains rare and of low quality, making it difficult to strongly recommend individual treatment options. However, multimodal treatment modalities using physical therapy and psychotherapy may help patients and provide useful tools for coping with this condition. There are also useful non-surgical and surgical options for CSP that depend on the patient's state, the severity of the complaint and what options have already been tried.
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Affiliation(s)
- Amr Moubasher
- Urology, King's College Hospital, London, GBR
- Dermatology and Andrology, Assiut University, Assiut, EGY
| | | | - Nicholas Raison
- Urology, MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, GBR
| | - Oliver Brunckhorst
- Urology, MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, GBR
| | - Kamran Ahmed
- Urology, King's College Hospital, London, GBR
- Urology, MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, GBR
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Witherspoon L, Fitzpatrick R, Patel P, Flannigan R, Roberts MT, Krakowsky Y, Campbell JD, Grantmyre J, Brock GB, Goldenberg SL, Jarvi KA. Clinical pearls to managing men's health conditions during the COVID-19 pandemic. Can Urol Assoc J 2020; 14:E161-E166. [PMID: 32369009 DOI: 10.5489/cuaj.6631] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Luke Witherspoon
- Division of Urology, Department of Surgery, The Ottawa Hospital and University of Ottawa, Ottawa, ON, Canada
| | - Ryan Fitzpatrick
- Division of Urology, Department of Surgery, Mount Sinai Hospital, Toronto, ON, Canada
| | - Premal Patel
- Section of Urology, University of Manitoba, Winnipeg, MB, Canada
| | - Ryan Flannigan
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Matthew T Roberts
- Division of Urology, Department of Surgery, The Ottawa Hospital and University of Ottawa, Ottawa, ON, Canada
| | - Yonah Krakowsky
- Division of Urology, Department of Surgery, Mount Sinai Hospital, Toronto, ON, Canada
| | - Jeffrey D Campbell
- Department of Surgery, Division of Urology Western University, London, ON, Canada
| | - John Grantmyre
- Department of Urology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Gerald B Brock
- Department of Surgery, Division of Urology Western University, London, ON, Canada
| | - S Larry Goldenberg
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Keith A Jarvi
- Division of Urology, Department of Surgery, Mount Sinai Hospital, Toronto, ON, Canada.,Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
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Spermatic Cord Denervation for Chronic Orchialgia. CURRENT SEXUAL HEALTH REPORTS 2018. [DOI: 10.1007/s11930-018-0178-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Affiliation(s)
| | - Keith Jarvi
- Division of Urology, University of Toronto, Toronto, ON
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Abstract
PURPOSE OF REVIEW Chronic scrotal pain (CSP) is a common yet poorly understood condition, with significant impacts on overall quality of life. Many patients will have sought evaluation and management from multiple providers in an attempt to find a solution for their pain. RECENT FINDINGS Despite many emerging treatments for CSP and further understanding of the potential etiologies and pathophysiological basis of the condition, its natural history is poorly understood. It is also important to recognize the psychosocial impact of CSP and consider formal referral for psychological evaluation and treatment if the patient endorses significant psychiatric responses to pain. It is important to also recognize the neuropathic component of pain that may arise in patients with CSP. Neuropathic medications show promise as a narcotic-sparing pharmacological intervention. There are promising surgical options for CSP including microsurgical denervation of the spermatic cord. This article highlights the current best practice recommendations on the evaluation and management of chronic scrotal pain.
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Affiliation(s)
- Christopher Wu
- Mount Sinai Hospital-Toronto, 60 Murray Street, 6th Floor, Toronto, ON, M5T 3L9, Canada
| | - Keith Jarvi
- Mount Sinai Hospital-Toronto, 60 Murray Street, 6th Floor, Toronto, ON, M5T 3L9, Canada.
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