Chronic orchialgia is defined as 3 months of intermittent or constant testicular pain that is significantly bothersome to the patient. It is the cause of about 2.5% to 5% of all urology consultations and currently affects about 100,000 men in the United States each year. When it cannot be directly be attributed to any specific, identifiable source, the condition is called idiopathic chronic orchialgia.
Evaluation can be confusing as the underlying cause is often idiopathic and conservative therapy is often unsuccessful making this a challenging condition to diagnose and treat. Conservative therapy is usually tried first, but more invasive treatments are used when first-line options fail. Surgical options include spermatic cord blocks, varicocelectomy, epididymectomy, vasovasostomy (if the patient has had a vasectomy), microsurgical denervation of the spermatic cord (MDSC), botulinum toxin injections, and orchiectomy.
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