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    Chronic scrotal pain: How you can assist patients

    Daniel Shoskes, MDDaniel Shoskes, MDChronic orchialgia affects nearly 5% of men presenting to urology clinics, yet remains “one of the great understudied conditions in urology,” according to Daniel Shoskes, MD. In this interview, Dr. Shoskes discusses his evaluation of patients with scrotal pain, outlines his use of conservative treatments, and explains surgical approaches and how he decides whether to use them. Dr. Shoskes is professor of urology at Cleveland Clinic’s Glickman Urological & Kidney Institute and director of the Novick Center for Clinical and Translational Research. He was interviewed by Urology Times Editorial Consultant Philip M. Hanno, MD, MPH, clinical professor of urology at Stanford University School of Medicine, Stanford, CA.


    Let me begin with a true anecdote to show the desperation of patients with chronic orchialgia. When I was a senior registrar in England 36 years ago, cases to be scheduled were put on 3x5 cards and the wait list was about 2 years for some elective surgeries. A 24-year-old man with intractable orchialgia who begged for bilateral orchiectomy was placed on the wait list in the hopes that symptoms would ultimately improve, with no one thinking he would ever come to bilateral orchiectomy. Unfortunately, the junior registrar pulled his card down to do the case because he was not familiar with the story and wanted to do an orchiectomy. Somehow, it went through the system. Does this surprise you?

    It doesn’t surprise me on a number of levels, especially since I spent a couple of years in England, and I know how that system works. I’m not trying to pick on the British system.

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    Chronic orchialgia is—and I believe remains—one of the great understudied conditions in urology. You can tell how understudied a condition is by the dismissive terms we use for it.

    When I started working in the area of chronic prostatitis in the mid-1990s, the running joke was, “Who do you see for chronic prostatitis? The most junior person on faculty.” Along the same lines, the joke with orchialgia is, “Chronic orchialgia, what is it? Just another guy with ball pain.” There are descriptions in the military that that’s what people complain about when they want to get off of work. And yet, when you begin to see these patients, just as the women who were leaking urine and just as the men who had chronic prostatitis before them, they’re not all crazy, they’re not all faking. Many are very reasonable men with real pain and real impact on their quality of life. We owe it to them to study the condition, understand the phenotype of the problem, and come up with therapies to help them just as we do with other “sexier” areas in urology.

    Next: "It’s probably only people with more of a specialty interest who even bother to code this as chronic orchialgia or chronic scrotal content pain."

    Philip M. Hanno, MD, MPH
    Philip M. Hanno, a Urology Times editorial consultant, is professor of urology at the University of Pennsylvania, Philadelphia.


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