University of Western Australia, Perth, Australia; Princess Margaret Hospital for Children, Perth, Australia.
University of Western Australia, Perth, Australia.
J Pediatr Urol. 2016 Jun;12(3):168.e1-6. doi: 10.1016/j.jpurol.2015.11.014. Epub 2015 Dec 31.
The aim was to review the pediatric cohort undergoing surgical exploration for acute scrotal pain at our institution and assess the entity of chronic orchalgia post exploration in this cohort.
A retrospective review of all pediatric patients who underwent surgery for acute scrotal pain at a single institution between 1 January 2001 and 1 January 2012 was conducted.
A total of 1084 patients underwent scrotal exploration for acute scrotal pain where the underlying cause could not be clinically ascertained. Causes found at exploratory surgery are shown in the table. Forty-four children (4.1%) re-presented with another episode of acute scrotal pain and underwent re-exploration. A hundred of the 772 children with testicular appendage torsion at initial exploration had unilateral exploration only. Seven (7%) of these re-presented with contralateral appendage torsion. The complication rate of initial scrotal exploration was 5.6% and that of re-exploration was 6.8%. All complications were managed conservatively except for a painful reactive hydrocele that underwent the Jaboulay procedure. Fifteen (1.4%) children in this cohort developed chronic orchalgia. Thirteen (87%) of these had definite pathology found at initial exploration. One of 61 (2%) with postoperative complications (a reactive hydrocele) developed chronic orchalgia. Pediatric chronic pain specialists were consulted for all patients. In 10 of the 15 (67%), significant comorbidities included constipation, anxiety, somatization, hydrocele, dysfunctional voiding, and multiple joint pain. The Jaboulay procedure for reactive hydrocele and re-exploration to pex the testes due to suspected intermittent testicular torsion resolved chronic orchalgia in one patient each.
Pediatric chronic orchalgia post exploration is uncommon. It has a multifactorial etiology. Comorbidities are common. It is possible that some unexplored patients labeled as chronic orchalgia in the literature may have underlying correctable pathology. Surgically correctable pathology such as intermittent testicular torsion, metachronous testicular appendage torsion, and symptomatic hydrocele or varicocele should be excluded in children with chronic orchalgia. Chronic pain specialists should be consulted and associated comorbidities managed. Prior surgical exploration and testicular fixation in children with chronic orchalgia helped reassure patients and families that there was no underlying surgical cause for the pain and facilitated compliance with chronic pain management.
Pediatric chronic orchalgia has a multifactorial etiology and is uncommon after scrotal exploration surgery. Comorbidities are common and must be managed. Surgical exploration helps reassure patients that there is no correctable cause for the pain and facilitates engagement with chronic pain management.
本研究旨在回顾本机构因急性阴囊疼痛而行手术探查的儿科患者队列，并评估该队列在探查后的慢性睾丸痛程度。
对 2001 年 1 月 1 日至 2012 年 1 月 1 日期间在单一机构因急性阴囊疼痛而行手术的所有儿科患者进行了回顾性研究。
共有 1084 例患者因无法通过临床确定病因而行阴囊探查术。探查手术发现的病因见表。44 例（4.1%）患儿因急性阴囊疼痛再次就诊，行再次探查。772 例睾丸附件扭转患儿中，100 例仅行单侧探查。其中 7 例（7%）出现对侧附件扭转。初次阴囊探查术的并发症发生率为 5.6%，再次探查术的并发症发生率为 6.8%。除 1 例因反应性鞘膜积液行 Jaboulay 手术而接受保守治疗外，所有并发症均得到了处理。该队列中有 15 例（1.4%）患儿出现慢性睾丸痛。其中 13 例（87%）在初次探查时发现明确的病理改变。1 例（2%）术后并发症（反应性鞘膜积液）患儿出现慢性睾丸痛。所有患儿均咨询了儿科慢性疼痛专家。在 15 例（67%）慢性睾丸痛患儿中，有明显的合并症，包括便秘、焦虑、躯体化、鞘膜积液、排尿功能障碍和多处关节痛。Jaboulay 手术治疗反应性鞘膜积液和因疑似间歇性睾丸扭转而再次探查睾丸固定术，各有 1 例患者的慢性睾丸痛得到缓解。
儿童术后慢性睾丸痛并不常见，其病因多因素，常合并多种合并症。文献中报道的一些被标记为慢性睾丸痛的未探索患者可能存在潜在的可纠正的病理学。应排除慢性睾丸痛患儿的间歇性睾丸扭转、并发睾丸附件扭转、症状性鞘膜积液或精索静脉曲张等可手术纠正的病理学。应咨询慢性疼痛专家并治疗相关合并症。对于慢性睾丸痛患儿，既往手术探查和睾丸固定术有助于使患者和家属确信疼痛没有潜在的手术原因，并促进对慢性疼痛管理的依从性。
儿童慢性睾丸痛的病因多因素，阴囊探查术后并不常见。常合并多种合并症，必须加以处理。手术探查有助于使患者确信疼痛没有可纠正的原因，并促进对慢性疼痛管理的参与。
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