A review of the efficacy of surgical treatment for and pathological changes in patients with chronic scrotal pain

OBJECTIVES To assess the efficacy of surgical treatment for chronic scrotal pain (CSP) and to examine histopathological changes in epididymectomy and orchidectomy specimens in these patients. PATIENTS AND METHODS CSP is a rare condition that for some patients can be severely debilitating. Although first‐line treatment is conservative and includes the use of analgesics, many patients still complain of persistent pain. Nerve denervation and spermatic cord block might be attempted, but often patients proceed to surgery. The clinical notes of 26 patients (mean age 49 years) who had surgery for CSP were analysed retrospectively. Data included: the duration of pain before presentation, investigations before treatment, risk factors for CSP, initial conservative management, pain team referral, history of previous scrotal surgery and clinical outcome. All pathological specimens were examined to identify any changes in the epididymis and testis. RESULTS In 16 patients (62%), the pain resolved completely after surgery, but the other 10, despite showing an improvement, had residual pain. Histopathological examination of epididymectomy specimens revealed changes associated with obstruction, including sperm extravasation, tubule distension and focal fibrosis. All testis specimens had a variable degree of tubular sclerosis and chronic inflammation, with nine showing extensive infarction, suggestive of previous episodes of infection or ischaemia. CONCLUSION In this review, 62% of patients had complete resolution of pain and the remainder had a partial response after surgical treatment for CSP. All specimens showed pathological changes in the epididymis or testis, with changes suggestive of recurrent episodes of ischaemia or infection. The results show that CSP can be successfully treated surgically in many cases where conservative methods fail to provide symptomatic relief.