Chronic Testicular Pain Treated with Spinal Cord Stimulation
Victoria Yakovleva | Beth E. Resch, APNP | Alexander E. Yakovlev, MD
BACKGROUND AND AIMS
Testicular pain caused by orchitis, epididymitis, post-surgical pain, trauma, tumors, hernia, torsion, varicocele, hydrocele or spermatocele usually resolves with treatment of causative condition. Chronic pain despite treatment is difficult to treat. Surgical interventions including orchectomy, epididymectomy or spermatic cord stripping are not always effective at relieving the pain. Spinal cord stimulation (SCS) may be an effective treatment option for patients with chronic testicular pain refractory to conservative treatment.
MATERIALS AND METHODS
The patient was a 28-year-old male with a 2-year history of constant left testicular pain following vasectomy, worse with sexual intercourse and movement, who had minimal relief from medication management, physical therapy, ileoinguinal and genitofemoral nerve blocks. Urologists offered orchectomy but he instead chose to undergo SCS trial. Following successful trial of percutaneous placement of two 8-electrode epidural leads (Medtronic Inc., Minneapolis, MN) with epidural access gained at the T12-L1 interspace and final leads positioned at T8-T9-T10. With greater than 50% improvement of the pain, the patient underwent placement of permanent leads and RestoreULTRA (Medtronic Inc., Minneapolis, MN) rechargeable generator two weeks later.
RESULTS
After final implantation the patient reported significant pain relief (>90% reduction in VAS) with permanent stimulator. He was able to discontinue use of all oral pain medications and reported other positive outcomes including ability to return to work and adequate pain relief during sexual intercourse.
FIGURES
CONCLUSION
SCS may be a therapeutic alternative for patients with chronic testicular pain who in the past exhausted all conservative treatment options.
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