Arizona Pain Specialist, Scottsdale, AZ 85258, USA.
Pain Physician. 2009 Nov-Dec;12(6):991-5.
Chronic testicular pain, or "chronic orchalgia," is defined as testicular pain 3 months or longer in duration that significantly interferes with the daily activities of the patient. For patients failing to respond to conservative treatment, microsurgical denervation of the spermatic cord, epididymectomy, and vasovasostomy have all shown a degree of relief. However, these are all invasive procedures and no treatment has proven efficacy when these options fail. We present a case of a male who presented with over a decade of chronic right-sided testicular pain secondary to recurrent epididymitis. Before arriving at our clinic the patient had an epididymectomy performed with no appreciable improvement in pain. Initially ilioinguinal, iliohypogastric, and genetofemoral nerve blocks; right-sided S1, S2, and S3 transforaminal epidural steroid injections (TFESIs) with inferior hypogastric blocks; and right-sided T12-L1, L1-L2, and L2-L3 TFESIs all failed to provide pain relief. After conservative therapies had failed, a sacral nerve stimulation trial was done via a caudal epidural approach. The permanent implant has provided the patient with sustained 80% decrease in pain at 4 months status post permanent sacral nerve stimulation implant. The above case demonstrates the potential benefit of sacral nerve stimulation with neuropathic intractable testicular pain in a patient that failed conservative treatment. In this case, the patient had exhausted medical and surgical management, including advanced interventional pain options. We were unable to find any previous published cases of neurostimulation used as a modality of treatment for testicular pain, and further studies are needed to gain a better understanding of the efficacy in this setting.
慢性睾丸痛，又称“慢性睾丸痛”，定义为睾丸疼痛持续 3 个月或以上，且显著干扰患者的日常活动。对于保守治疗无效的患者，精索神经显微切断术、附睾切除术和输精管-血管吻合术均显示出一定程度的缓解。然而，这些都是侵入性的程序，当这些选择失败时，没有治疗方法被证明有效。我们报告了一例男性患者，他因复发性附睾炎而出现十多年的慢性右侧睾丸痛。在我们的诊所就诊之前，该患者已经进行了附睾切除术，但疼痛没有明显改善。最初进行了髂腹股沟、髂腹下和生殖股神经阻滞；右侧 S1、S2 和 S3 经椎间孔硬膜外类固醇注射（TFESI）联合下腹下丛阻滞；以及右侧 T12-L1、L1-L2 和 L2-L3 TFESI 均未能缓解疼痛。在保守治疗失败后，进行了骶神经刺激试验，通过硬膜外后入路进行。永久性植入物使患者的疼痛减轻了 80%，持续 4 个月。上述病例表明，骶神经刺激对保守治疗无效的神经性难治性睾丸痛具有潜在益处。在这种情况下，患者已经用尽了包括先进的介入性疼痛管理在内的医疗和手术管理。我们无法找到任何先前发表的使用神经刺激作为睾丸痛治疗方式的案例，需要进一步研究以更好地了解这种情况下的疗效。
