Department of Urology, University of Michigan, Ann Arbor, Michigan.
Department of Urology, University of California, Los Angeles, Santa Monica, California.
Urol Pract. 2024 Mar;11(2):409-415. doi: 10.1097/UPJ.0000000000000515. Epub 2024 Jan 12.
Chronic scrotal pain is difficult to manage, and epididymectomy is a treatment option for a subset of men with pain localized to the epididymis. We sought to evaluate the efficacy of epididymectomy at our institution.
Between 2000 and 2020, 225 men underwent epididymectomy at our institution for pain localized to the epididymis and not part of a greater constellation of pelvic pain or urinary symptoms. Our primary outcome measure was change in pain after epididymectomy, categorized as cured/improved or no change/worsened. Multivariable logistic regression compared the impact of pain duration, and surgical and psychiatric histories on postoperative pain.
Patients in both outcome categories-cured/improved and no change/worsened-were similar in age and BMI. Overall, 162 patients (72%) reported cured/improved pain at the last documented follow-up visit. Median follow-up time was 12 (IQR 1-364) weeks. About half of the cohort (n = 117, 52%) had a prior vasectomy, and there was no difference in outcome based on vasectomy history on multivariate analysis (OR 0.625, = .3). Men with pain duration 1 year (OR 0.46, = .03), diagnosed psychiatric conditions (OR 0.44, = .04), or prior scrotal/inguinal/abdominal surgeries other than vasectomy (OR 0.47, = .03) had decreased odds of pain relief after epididymectomy.
This 20-year analysis is the largest review of postepididymectomy outcomes reported. Among carefully screened men, 72% had resolution or improvement of scrotal pain. Epididymectomy is most effective for men with < 1 year of focal epididymal pain, with no history of psychiatric conditions or scrotal/inguinal/abdominal surgery other than vasectomy.
慢性阴囊疼痛难以治疗，附睾切除术是疼痛局限于附睾的一部分男性的治疗选择。我们旨在评估我们机构中附睾切除术的疗效。
在 2000 年至 2020 年间，我们机构对 225 名因疼痛局限于附睾且不属于更大的骨盆疼痛或尿路症状综合征的男性进行了附睾切除术。我们的主要观察指标是附睾切除术后疼痛的变化，分为治愈/改善或无变化/恶化。多变量逻辑回归比较了疼痛持续时间、手术和精神病史对术后疼痛的影响。
在治愈/改善和无变化/恶化这两种结果类别中，患者在年龄和 BMI 方面相似。总体而言，162 名患者（72%）在最后一次有记录的随访中报告疼痛得到缓解。中位随访时间为 12（IQR 1-364）周。大约一半的队列（n = 117，52%）有既往输精管切除术史，但多变量分析中，输精管切除术史对结果无影响（OR 0.625， =.3）。疼痛持续时间 > 1 年的男性（OR 0.46， =.03）、诊断出精神疾病的男性（OR 0.44， =.04）或除输精管切除术以外的既往阴囊/腹股沟/腹部手术的男性（OR 0.47， =.03），附睾切除术后疼痛缓解的可能性较低。
这是对附睾切除术后结果进行的最大的 20 年分析。在经过仔细筛选的男性中，72%的人阴囊疼痛得到缓解或改善。附睾切除术对疼痛持续时间<1 年、无精神疾病史或除输精管切除术以外的阴囊/腹股沟/腹部手术史的男性最有效。
