Scrotal pain as the name suggests is the pain in the testicular region and surrounding skin sac known as scrotum.
The pain is bothersome because of its location and often dull aching and severe in nature.
The pain may radiate or migrate to groin or the inguinal region.
Orchalgia can be chronic in nature as in persist despite treatment for long duration.
Oftentimes it reduces quality of life of the affected and may lead to alteration in lifestyle.
The root causes of Orchalgia may be associated with poor testicular reserves and lower semen parameters
Causes
- Infection of the testes or the epididymis (Epididymitis, Orchitis Or Epididymorchitis)
- Testicular Torsion
- Varicocele
- Hydrocele
- Inguinoscrotal hernia
- Rarely testicular tumour
Evaluation
Most often the infection of the testes and the epididymis are a spread from the urinary bladder down into the testes in a retrograde manner and are a result of poor inadequate urine stream or flow.
Apart from evaluating the infection of the testes or epididymis the root cause of the infection as in reduced urine stream (Uroflowmetry) or poor flow must also be diagnosed.
Rarely its Tuberculosis of the epididymis which can cause pain and knobby hardness of the epididymis.
For testing the same a PCR test of blood Chest X Ray and Skin test for Tuberculosis (Mantoux) test may be needed.
An Ultrasound of the scrotum may help discern any swelling or suspicious growth in the testes or surrounding sac (Tunica vaginalis)
An Ultrasound Doppler is the only sure way to diagnose Testicular Torsion which is a rare cause of severe excruciating pain in the testicles in adolescent aged male kids or young adults.
There is a twisting of testes around its own blood supply leading to ischaemia(strangulation) and loss of the organ.
Its diagnosis, right management is therefore utmost important in preventing the ominous.
Treatment
As discussed, the treatment depends upon the cause.
A simple surgery may cure Hydrocele
A Varicocele will on the other hand need a dedicated microsurgical ligation by a dedicated surgeon. (Urocentre is a centre of microsurgery and Microsurgical Varicocelectomy)
A testicular torsion will need an emergency diagnosis and procedure to detorse the strangulation.
For other causes such as Infections, a long term antibiotics along with measures to increase the urinary flow and prevent the reflux into testes and epididymis will help recurrence.
Tuberculosis can need its attendant therapy.
Chronic Orchalgia which is recurrent and bothersome may need prolonged treatment with antibiotics as well as nerve modulators. In rare circumstances it may need Neurolytic injections in the spermatic chord.
