CUA BPR on Chronic Scrotal Pain 2018

Question 1

What are thought to be the top 3 cause of chronic scrotal pain?

Answer 1

Unknown > Vasectomy > Trauma > Infection

Question 2

What is considered mandatory in initial work up of men with CSP?

Answer 2

History, Physical exam( including DRE and screening neurological exam in standing and seated position)

Question 3

Are men with history of abuse at risk of CSP?

Answer 3

YES

Question 4

What evaluation is considered optional in someone presenting with CSP?

Answer 4

Infection screen, Questionnarie, Scrotal US, Test Cord block, psychological evaluation, testicular function screening

Question 5

What are non-medical/surgical options for management of CSP?

Answer 5

Conservative management(reassurance, scrotal support, heat or cold therapy), physiotherapy, acupuncture, psychological counselling and therapies

Question 6

what are medical options for treatment of CSP?

Answer 6

4 weeks of NSAIDs, 4 weeks of antibiotics( fluoroquinolones or cephalosporins) specially if there is tenderness of epididymis, 4 weeks trial of gabapentin/pregabalin/nortryptiline( in presence of neuropathic pain), Nerve blockade( therapeutic and diagnostic)

Question 7

Is nerve blockade with botox/ radiofrequency ablation recommended for CSP

Answer 7

No, experimental, results are promising though.

Question 8

What are surgical management options for CSP?

Answer 8

Microsurgical vasovasostomy for post-vasectomy pain syndrome(PVPS), epididymectomy for PVPS and symptomatic epidydmal cysts, Varicocele repair for symptomatic patients, Microsurgical denervation of the cord, inguinal orchidectomy

Question 9

What percentage on men udnergoing vasectomy will have CSP?

Answer 9

1-2%

Question 10

What are potential side effects of MSDC?

Answer 10

persistent pain, persistent numbness, infection, bleeding, testicular atrophy, infertility, hydrocele formation