Presentation Authors: Parviz Kavoussi*, Austin, TX
Introduction: Chronic orchialgia, defined as unilateral or bilateral scrotal pain lasting at least three months in duration, is one of the most common complaints seen in the urologist&[prime]s office, and continues to be a challenging entity to diagnose and to treat. A careful history may elucidate the etiology in some men to be due to a hyperactive cremaster muscle reflex with testicular retraction. The objective of the study was to evaluate outcomes and complications in men who underwent microsurgical subinguinal cremaster muscle release (MSCMR).
Methods: A retrospective chart review was performed on men who underwent MSCMR by a single surgeon between September 2011 and July 2018.
Results: Between September 2011 and July 2018, fifteen men who presented with chronic orchialgia secondary to a hyperactive cremaster muscle reflex underwent MSCMR, six bilateral and nine unilateral. The mean age of the men was 39 years Â± 11. Candidacy for MSCMR included answering yes to the clinical question: &[Prime]at times of testicular pain, does the testicle retract up in the groin to the extent that you have to milk it back down to the scrotum?&[Prime] They must also have had normal digital rectal examinations, negative urinalyses, negative scrotal Doppler ultrasounds, and had pain localized to the testicle, epididymis, or spermatic cord, without an anatomic or pathologically identifiable etiology other than testicular retraction. Of the men who underwent MSCMR, 100% (15/15) had resolution of testicular retraction and 86.7% (13/15) had complete resolution of orchialgia. One of the men had a complication (6.7%) which was a scrotal hematoma which resolved with conservative management. No patients had a surgical infection or testicular atrophy.
Conclusions: MSCMR is an effective option for men with orchialgia secondary to testicular retraction due to a hyperactive cremaster muscle reflex.