Testicular or scrotal / groin pain is common in children and often there is no apparent cause. This paper describes the authors’ experience over 10 years of boys >10 years seeking medical attention with testicular pain without anatomical abnormality or other cause lasting more than three months and interfering with daily activities. It is a retrospective study and included 79 of 282 boys meeting inclusion criteria. The mean number of visits to the hospital was 0.27 (range 0-3). Sixty percent underwent a total of 67 imaging studies including ultrasound (91%), CT scan (7.5%) and MRI (1%). All imaging was either normal or with findings not sufficient to explain symptoms. Thirty-three of seventy-nine patients had concomitant medical problems and / or psychiatric – behavioural issues. Treatment included anti-nociceptive drugs such as acetaminophen and non steroidals, and supportive care including scrotal support, bowel and bladder management. Of the 79 patients, 38 were only seen once and 41 more than once. Of the 41, 11 patients were referred to the pain clinic of which 10 have been evaluated. Sixteen of forty-one had resolution of the pain. Seven out of ten who were referred to the pain clinic had resolution of pain (three managed with either amitryptylin or gabapentin, four with nerve blocks). The authors conclude from their series that patients with paediatric orchalgia utilise significant health resources and had multiple co-morbidities. Surgical intervention is rarely needed.

Pediatric chronic orchalgia: patient population and patterns of care.
Ching C, Hays S, Kaffenberger S, et al.
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Henrik Steinbrecher

Southampton University Hospital NHS Trust

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