Outcomes for surgical management of orchalgia in patients with identifiable intrascrotal lesions

Objective: The outcome of surgery for relief of orchalgia in patients with identifiable intrascrotal pathology is not well defined. We evaluated the success of commonly performed surgical procedure indicated for pain relief in patients with specific intrascrotal lesions. Methods: Surgical cases performed for relief of painful scrotal pathology were reviewed, including ligation of internal spermatic vein, hydrocelectomy, spermatocelectomy, and orchiopexy for suspected intermittent torsion. Relief of pain as reported to the physician and time for return to full activity were determined. Pain relief was compared to a 50% placebo rate using Fisher's exact test. Results: Eigthy-five of 151 patients (56%) undergoing surgery for pain relief had complete data and adequate follow-up for analysis. Of 40 patients who had ligation of the internal spermatic vein, 30 (75%) were relieved of pain (p = 0.037). All 19 patients with painful hydroceles and 16 of 17 (94%) with spermatoceles were relieved of pain (p < 0.001). Of 9 patients undergoing scrotal orchiopexy for suspected intermittent torsion, 8 (89%) were pain-free (p < 0.001). Conclusion: Surgical management of specific intrascrotal lesions is highly effective.