Treatment of Chronic Testicular Pain
The causes of chronic testicular pain not due to infection are not well understood, however; it is believed that nerve fibers running along the spermatic cord (the cord which also contains the vas deferens and blood vessels to the testicle) can be triggered to cause this pain. In men without a structural abnormality and testicular pain that does not respond to conservative therapy, surgical therapy can be considered. For men in this position who respond to a nerve block in the clinic, approximately 70% will have complete relief of pain with a specialized minimally invasive microscopic surgery to denervate the spermatic cord.
Adult Circumcision
Uncircumcised men can suffer from a condition known as phimosis, when the foreskin becomes tight and cannot be retracted back over the head of the penis. This can cause discomfort, irritation, difficulty with urination, and pain or even cracking of the skin with erections and intercourse. This can be treated with topical medications or can be definitively treated with a circumcision.
Repair of Incomplete Circumcision in Adults
Some men who have undergone circumcision in the past may have some redundant foreskin left behind which can cause similar problems as listed above under adult circumcision. A circumcision revision can alleviate these problems.
Treatment of Spermatoceles
A spermatocele or epididymal cyst, is a non-cancerous fluid filled cyst that is an outpocketing from the epididymis (the structure on the testicle where sperm mature). It is estimated that 30% of all men have spermatoceles. Over time, spermatoceles will either stay the same size or grow larger. Spermatoceles that grow large or cause pain can be surgically removed, but the timing of doing so should be considered carefully as this treatment may impact the man’s fertility.
Treatment of Hydroceles
Hydroceles in adults present as swelling of the scrotum caused by excessive fluid secretion by the layer of tissue tightly covering the testicle without adequate reabsorption by the sack surrounding the testicle. Hydroceles will either stay the same size or grow larger. If a hydrocele becomes large enough it can cause discomfort, heaviness, or may be cosmetically unpleasing. In these cases, the hydrocele can be surgically repaired.
Reduction Scrotoplasty
A man with an enlarged scrotum may undergo a reduction scrotoplasty to decrease the size.
Placement of Testicular Prosthesis
Men who have absence of one or both testicles due to absence from the time of birth, loss of testicle due to torsion (twisting), trauma, or cancer may undergo placement of a saline filled testicular prosthesis. The prosthesis is designed to have the texture, weight, and shape of the natural testis and is sized at the time of surgery to match the natural testis in men having one prosthesis placed.
Dr. Kavoussi is not only very experienced in such treatments, but has written the textbook chapters describing the surgical techniques for many of the procedures listed above in the textbooks used by urologists around the globe. (Parviz K. Kavoussi, Raymond A. Costabile. Chapter 37, Surgery of the Scrotum and Seminal Vesicles. Campbell-Walsh Urology, 10th edition. Saunders Co. Wein, Kavoussi, Partin, Peters, eds. ; as well as Parviz K. Kavoussi, Raymond A. Costabile. Chapter 23, Disorders of Scrotal Contents: Orchitis, Epididymitis, Testicular Torsion, Torsion of the Appendages, and Fournier’s Gangrene. Practical Urology: Essential Principles and Practice. Springer Co. Chapple, Steers, eds.)
