Volume 21, Number 1Case ReviewUse of Spermatic Cord Block Systematically Identifies a Paraspinal Tumor as Source of OrchialgiaMason HoltelRobert J Baranello JrAllyson HalePatrick SpringhartOrchialgia is a common urologic complaint with a myriad of etiologies. Workup for orchialgia requires a broad differential diagnosis and a thorough understanding of relevant anatomy. We report the case of a 43-year-old man who presented to a urologist with right testicular pain. Following a negative workup, the patient received a spermatic cord block for therapeutic and diagnostic purposes. Two months after the block, the patient returned with new complaints of ipsilateral inner thigh paresthesias, suggesting a pathologic process proximal to the genital branch of the genitofemoral nerve. A subsequent MRI of the lumbosacral spine revealed a paraspinal mass involving nerve roots at L1-2. We highlight the utility of the spermatic cord block and its role in the diagnosis of a paraspinal tumor as an uncommon cause of orchialgia. [Rev Urol. 2019;21(1):49–52] © 2019 MedReviews®, LLCOrchialgiaNeuropathic painTesticular painSpermatic cord blockGenitofemoral nerveParaspinal tumor
Volume 21, Number 2Review ArticlesEvaluation and Management of Chronic Scrotal Content Pain—A Common Yet Poorly Understood ConditionManagement ReviewMatthew J ZiegelmannRyan FarrellLaurence A LevineChronic scrotal content pain (CSCP) refers to bothersome pain localized to structures within the scrotum that has been present for ≥ 3 months. Etiologies include infection, trauma, and referred pain from the spine, abdomen, and retroperitoneum. However, in many patients there is no obvious identifiable cause. The initial evaluation should include a thorough history and physical examination with adjunctive imaging and laboratory tests as indicated. Treatments vary based on the underlying etiology and include both nonsurgical and surgical options with high levels of success when selectively utilized. The spermatic cord block with local anesthetic is an important tool that helps identify those patients who may benefit from surgery such as microscopic denervation of the spermatic cord. Other treatments including pelvic floor physical therapy may also be indicated in specific circumstances. Using a thoughtful and thorough approach to evaluation and treatment of CSCP, urologists can work with patients to achieve significant improvements in quality of life. [Rev Urol. 2019;21(2/3):74–84] © 2019 MedReviews®, LLCOrchialgiaTesticlePain inguinalDenervation