[Epididymal and testicular chronic pain]

Abstract

Objective: To list clinical and ethiopathogenical elements relevant to the analysis of an epididymal and testicular pain.

Material and methods: Review of published articles on the subject in the Medline(®) (PubMed(®)) database, selected according to their scientific relevance.

Results: Assessment of a chronic epididymal and testicular pain is mostly clinical and should: (1) eliminate local urological disorder; (2) suggest a neurological problem, based on signs and semiology; (3) suggest injury of nervous truncus according to medical history and scars; (4) detect referred pains, primarily back and thoracolumbar pains. The causal link between epididymal cysts, surgical aftereffect, local infection and chronic epididymal and testicular pain is not established with certainty. Spermatic cord nerve block, as a diagnostic test, should be done before undergoing any invasive procedure.

Conclusion: The fundamental notion is being able to distinguish epididymal and testicular pain and scrotal pain, because the testis has an abdominal origin, and therefore a sympathetic instead of sacral innervation. An absence evident somatic or iatrogenous cause should suggest hypersensibility to pain. Assessment of an epididymal and testicular pain requires a global clinical examination, which should take into account every aspect of the pain, including its functional and emotional components.