Mael Zuercher1, Lisa Nicole D'Alessandro2,3, Stephen Charles Brown2, Armando Lorenzo4, David Levin2. 1. Department of Anesthesia and Pain Medicine, Hospital for Sick Children and University of Toronto, Toronto, ON, Canada. mael.zuercher@gmail.com. 2. Department of Anesthesia and Pain Medicine, Hospital for Sick Children and University of Toronto, Toronto, ON, Canada. 3. Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada. 4. Department of Urology, Hospital for Sick Children and University of Toronto, Toronto, ON, Canada.
Abstract
PURPOSE: Chronic scrotal content pain, chronic orchialgia, or testicular pain can present after trauma, vasectomy, and hernia repair, among other triggers. Microsurgical denervation of the spermatic cord is an option for definitive pain control. While this practice is established in adult urology, access to diagnostic intervention and definitive denervation surgery is limited in the pediatric population. CLINICAL FEATURES: We report a case of definitive resolution of testicular pain with microsurgical denervation of the spermatic cord in a pediatric patient with post-traumatic chronic orchialgia that significantly reduced his daily activities and worsened his anxiety prior to this treatment. The patient underwent attempts at conservative medication-based management, followed by diagnostic spermatic cord nerve block before definitive denervation surgery. CONCLUSIONS: The incidence of chronic pain in pediatrics is substantial and is estimated to be around 20%. Orchialgia remains difficult and problematic to treat. Mental health diagnoses such as anxiety and depression are also significantly associated with chronic pain. Following consideration and implementation of steps for all these concerns, a diagnostic block and microsurgical denervation led to successful resolution of chronic testicular pain in a pediatric patient.
PURPOSE: Chronic scrotal content pain, chronic orchialgia, or testicular pain can present after trauma, vasectomy, and hernia repair, among other triggers. Microsurgical denervation of the spermatic cord is an option for definitive pain control. While this practice is established in adult urology, access to diagnostic intervention and definitive denervation surgery is limited in the pediatric population. CLINICAL FEATURES: We report a case of definitive resolution of testicular pain with microsurgical denervation of the spermatic cord in a pediatric patient with post-traumatic chronic orchialgia that significantly reduced his daily activities and worsened his anxiety prior to this treatment. The patient underwent attempts at conservative medication-based management, followed by diagnostic spermatic cord nerve block before definitive denervation surgery. CONCLUSIONS: The incidence of chronic pain in pediatrics is substantial and is estimated to be around 20%. Orchialgia remains difficult and problematic to treat. Mental health diagnoses such as anxiety and depression are also significantly associated with chronic pain. Following consideration and implementation of steps for all these concerns, a diagnostic block and microsurgical denervation led to successful resolution of chronic testicular pain in a pediatric patient.
Authors: Linda Clare; Catherine Quinn; Zoe Hoare; Rhiannon Whitaker; Robert T Woods Journal: Health Qual Life Outcomes Date: 2014-12-09 Impact factor: 3.186