Sibert L, Rigaud J, Delavierre D, Labat J-J
Service d'urologie, EA 4308, hôpital Charles-Nicolle, CHU de Rouen, université de Rouen, 1, rue de Germont, 76000 Rouen, France.
Prog Urol. 2010 Nov;20(12):1060-5. doi: 10.1016/j.purol.2010.08.005. Epub 2010 Sep 29.
To resume available therapeutic options for intra scrotal chronic pain, including surgical procedures, and to analyze their efficiency through a review of published data.
Review of articles published on this topic in the Medline (PubMed) database, selected according to their scientific relevance.
Initial treatment of epididydimal and testicular pain should always be conservative. Mean success rates of the different therapeutic options varies from 27% to 90%. Surgery on the scrotal content should be considered only if: (1) Pain can be explained by a local intra scrotal cause; (2) Medical and conservative treatments have failed; (3) Nerve block has been tried and is efficient in relieving pain; (4) Patients are informed of the risk of failure. Conservative surgical procedure (epididymectomy, vasovasostomy) have a success rate of 50-70%. Microsurgical spermatic cord denervation yields better results, while preserving testis and epididymis integrity. Failure is still possible (15%). Orchidectomy should be avoided if possible.
Levels of evidence concerning indications and efficiency of these surgical procedures are low. Patients suffering from recurring or implacable chronic testicular and epididymal pain require a multidisciplinary care.
总结阴囊内慢性疼痛的可用治疗方案，包括外科手术，并通过回顾已发表的数据来分析其疗效。
回顾Medline（PubMed）数据库中发表的关于该主题的文章，根据其科学相关性进行筛选。
附睾和睾丸疼痛的初始治疗应始终采取保守治疗。不同治疗方案的平均成功率在27%至90%之间。仅在以下情况时才应考虑对阴囊内容物进行手术：（1）疼痛可由阴囊内局部原因解释；（2）药物和保守治疗失败；（3）已尝试神经阻滞且能有效缓解疼痛；（4）告知患者有失败风险。保守性外科手术（附睾切除术、输精管吻合术）的成功率为50%至70%。显微外科精索去神经术效果更佳，同时可保持睾丸和附睾的完整性。仍有失败的可能（15%）。应尽可能避免睾丸切除术。
关于这些外科手术的适应证和疗效的证据水平较低。患有复发性或顽固性慢性睾丸和附睾疼痛的患者需要多学科护理。
