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CUA: Chronic Scrotal Pain (2018): Difference between revisions

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== Anatomy ==
== Anatomy ==


* See Testicle Anatomy Chapter Notes
* See [[Testicle|Testicle Anatomy Chapter Notes]]
* '''Testicular innervation'''
* '''Testicular innervation'''
** '''Sensory innervation of the scrotum and scrotal contents occurs via 2 somatic nerves:'''
** '''Sensory innervation of the scrotum and scrotal contents occurs via 2 somatic nerves:'''
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==== Mandatory ====
==== Mandatory ====


===== '''History and Physical Exam''' =====
===== History and Physical Exam =====
* '''<span style="color:#ff0000">History'''
* '''<span style="color:#ff0000">History'''
** Characterize pain (onset, location, quality, severity, referral, psychosocial impact, aggravating/alleviating factors)
** Characterize pain (onset, location, quality, severity, referral, psychosocial impact, aggravating/alleviating factors)
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** Prior evaluations/interventions for the presenting pain, as well as whether any prior treatment has brought relief
** Prior evaluations/interventions for the presenting pain, as well as whether any prior treatment has brought relief
** History of psychological, physical, or sexual abuse
** History of psychological, physical, or sexual abuse
*** Men with a history of abuse are at increased risk of CP/CPPS
*** Males with a history of abuse are at increased risk of CP/CPPS
* '''<span style="color:#ff0000">Physical exam (4)'''
* '''<span style="color:#ff0000">Physical exam (4)'''
*# '''<span style="color:#ff0000">Scrotum'''
*# '''<span style="color:#ff0000">Scrotum'''
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===== Other =====
===== Other =====
* '''Questionnaire'''
* '''Questionnaire'''
** '''Chronic Epididymitis Symptom Index (CESI)''' measures the severity, frequency, and impact of chronic epididymitis; can serve as a useful tool for baseline evaluation, as well as follow-up
** '''Chronic Epididymitis Symptom Index (CESI)'''  
***Measures the severity, frequency, and impact of chronic epididymitis; can serve as a useful tool for baseline evaluation, as well as follow-up
* '''Spermatic cord block'''
* '''Spermatic cord block'''
** '''Can serve be both diagnostic and therapeutic''' in patients with idiopathic CSP
** '''Can serve be both diagnostic and therapeutic''' in patients with idiopathic CSP
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* Natural history remains poorly studied
* Natural history remains poorly studied
* See [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5994986/figure/f2-cuaj-6-161/ Figure 2] from Original Report
* See [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5994986/figure/f2-cuaj-6-161/ Figure 2] from Original Report
* '''First-line (3):'''
* '''<span style="color:#ff0000">First-line (3):'''
*# '''Lifestyle changes'''
*# '''<span style="color:#ff0000">Lifestyle changes'''
*#* '''Modification of aggravating activities, scrotal support, and heat or cold therapies'''
*#* '''Modification of aggravating activities, scrotal support, and heat or cold therapies'''
*# '''Physical therapy and acupuncture'''
*# '''<span style="color:#ff0000">Physical therapy and acupuncture'''
*#* May improve CSP related to pelvic floor muscle dysfunction or referred pain from radiculopathies
*#* May improve CSP related to pelvic floor muscle dysfunction or referred pain from radiculopathies
*# '''Psychological counselling'''
*# '''<span style="color:#ff0000">Psychological counselling'''
*#* May help treat maladaptive self-harming behaviours, prevent catastrophic thinking, and potentially decrease pain-related physical limitations
*#* May help treat maladaptive self-harming behaviours, prevent catastrophic thinking, and potentially decrease pain-related physical limitations
* '''Second-line (if conservative strategies fail)'''
* '''<span style="color:#ff0000">Second-line (if conservative strategies fail)'''
** '''Medical management'''
** '''<span style="color:#ff0000">Medical management'''
*** See [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5994986/table/t2-cuaj-6-161/ Table 2] from Original Guideline
*** See [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5994986/table/t2-cuaj-6-161/ Table 2] from Original Guideline
*** '''NSAIDs x 4 weeks'''
*** '''NSAIDs x 4 weeks'''
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***Longer-term nerve blockade modalities are still considered experimental, but early results are promising
***Longer-term nerve blockade modalities are still considered experimental, but early results are promising


* '''Third line: surgical management'''
* '''<span style="color:#ff0000">Third line: surgical management'''
** See Table 3 from Original Guideline
** See [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5994986/table/t3-cuaj-6-161/ Table 3] from Original Guideline
** '''The choice of initial surgical approach should be directed by the likely etiology of pain.'''
** '''The choice of initial surgical approach should be directed by the likely etiology of pain.'''
*# '''Vasectomy reversal in patients with post-vasectomy syndrome'''
*# '''Vasectomy reversal in patients with post-vasectomy syndrome'''
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