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UPJ INSIGHT Epididymectomy Is an Effective Treatment for Chronic Epididymal Pain
By: Renee M. Cole, DO, University of Michigan, Ann Arbor; Juan J. Andino, MD, University of California, Los Angeles; Stephanie Daignault-Newton, MS, University of Michigan, Ann Arbor; Susanne A. Quallich, PhD, University of Michigan, Ann Arbor; Miriam Hadj-Moussa, MD, University of Michigan, Ann Arbor | Posted on: 18 Mar 2024
Cole RM, Andino JJ, Daignault-Newton S, Quallich SA, Hadj-Moussa M. Epididymectomy is an effective treatment for chronic epididymal pain. Urol Pract. 2024;11(2):409-415.
Study Need and Importance
Chronic scrotal pain affects up to 100,000 men in the US annually. Despite this prevalence, it remains a challenging condition to evaluate and treat. In this work, we provide outcomes data on the largest postepididymectomy cohort to date highlighting how a surgery that does not require fellowship training in microsurgery may serve patients with pain that localizes to the epididymis on exam.
What We Found
In this 20-year analysis, 72% of men who underwent epididymectomy for pain localized to the epididymis or a vasal sperm granuloma had improvement or resolution of their pain. Importantly, pain > 1 year in duration; psychiatric history such as anxiety, depression, or chronic pain conditions; and prior history of scrotal, inguinal, or abdominopelvic surgery were associated with lower odds of pain relief after epididymectomy (Figure). Finally, the 20% pain medication refill rate remained stable despite state-specific legislative changes limiting postoperative opioid medications.
Limitations
This retrospective, single-institution study at a tertiary referral center may not be generalizable to all practice settings. Furthermore, pain improvement and resolution were determined by review of the electronic medical record as opposed to the use of validated pain score systems. Finally, pain medication refill rate remained stable despite state laws limiting prescription of postoperative opioids—it was not possible to determine the exact quantity of doses required to manage postoperative pain.
Interpretation for Patient Care
In men with chronic scrotal pain that localizes to the epididymis, after conditions such as pelvic floor dysfunction are ruled out, epididymectomy is a great tool in the armamentarium of all urologists with rates of pain improvement or resolution as high as 72%. Certain patient characteristics may be predictive of a poorer response which can aid in patient counseling. Stable postoperative pain medication refill rates support the need for ongoing effort to reduce opioid medication use for outpatient procedures.
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