Sacral nerves radiofrequency ablation in the neuropathic testicular pain treatment
Keywords:testicular pain, chronic orchialgia, radiofrequency ablation
Chronic testicular pain or “chronic orchialgia” is defined as pain in the testicles lasting more than 3 months, which significantly interferes with all types of patient activity. Chronic orchialgia as a clinical symptom can be a manifestation of a variety of diseases of the male sexual sphere. Most clearly it is manifested in orchitis, orchiepididymitis. Orchialgia may be often a manifestation of prostatitis, funiculitis, vesiculitis. This line of pathologies is in the area of professional interest of urologists. For its treatment conservative and surgical methods are used. The deadlock situation arises in the case of non-detection of organic pathology after a detailed examination of patient. Reader's attention should be attracted to experience the treatment of a 34-yearold patient who has applied for complaints of pain in the testicles after five years of unsuccessful custody by neurologists, urologists and andrologists. The examination data (MRI, ultrasound investigation, bacteriological study) did not reveal any pathology. A working diagnosis of chronic testicular pain was established. Under the radiological control, a diagnostic blockade of S3 roots was made from both sides using a neurolocation with a threshold value of 0.03 V. 5 mg of bupivacaine is introduced on each side. A positive effect was obtained – pain stopped for the duration of anesthesia. A few days later, radiofrequency ablation of S3 was carried out on both sides in the 70 °C mode, 120 sec. The procedure is completed by the introduction of a mixture of anesthetic and corticosteroid. Three-month post-procedural follow-up shows a significant reduction in the pain syndrome (from 8/10 to 1/10 on the VAS). This case quite convincingly demonstrates the success of the application of interventional radiofrequency methods in the treatment of neuropathic testicular pain.
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