It is our pleasure to present this introduction to a special issue of Translational Andrology and Urology (TAU) that is focused on “Chronic orchialgia”. As editors, our goal was to present a current, state-of-the-art and lucid perspective on this common and challenging condition. Established national experts, thought leaders, and rising stars in Andrology were invited to contribute and their efforts have coalesced into a comprehensive edition beginning with a description of the pervasiveness of this condition and ending with a thorough characterization of the psychological correlates which can co-manifest with this disease process. The manuscripts in this issue of the TAU journal provide all-encompassing updates and multi-disciplinary perspectives on our current understanding of chronic orchialgia.
Chronic orchialgia represents a diagnostic and therapeutic challenge for physicians. All practicing urologists, at some point, encounter a patient presenting with a history of chronic testicular pain. At present, no widely accepted guideline or algorithm exists to guide clinicians in the evaluation and management of this condition. It is far more common than often recognized with estimates reaching up to 100,000 US men per year. At least 50% of these patients present with an idiopathic etiology further confounding evaluation and treatment. While it is important to rule out medically reversible causes, significant health care resources are utilized in the management of this disease.
Conservative therapy is generally the mainstay of treatment in chronic orchialgia. Medical management is comprehensively reviewed as well as alternative and novel therapies to broaden the provider’s armamentarium when encountering these patients. When conservative options fail, surgical treatment can be considered. Surveys of urologists indicate that a knowledge gap exists in selecting the appropriate surgical approach in the management of this disease. When choosing surgical intervention, patient selection is paramount. The invited faculty has collectively proposed a multi-disciplinary algorithm in the diagnosis and treatment of chronic orchialgia. This hopefully will assist providers in determining when operative intervention may be appropriate and similarly, emphasize the necessity of effective preoperative counseling in men considering surgical intervention. Surgical management is generally broken down by etiology with experts in Andrology leading the way and capturing the nuances of their surgical approach. The collective manuscripts will also discuss the latest advances in microsurgical and robotic management of chronic orchialgia.
The editors would like to thank all the authors for their manuscript contributions. This issue would not exist without them and their tireless efforts in treating this complex disease, which affects a significant number of men. Thanks also to Professor Tom F. Lue (Editor-in-Chief, TAU) for his kind invitation to edit this special TAU journal issue on Chronic Orchialgia. It has similarly been a pleasure to work with Lucine M. Gao, Science Editor for TAU, who is to be commended for her efforts in bringing this edition to fruition. We hope that readers will find this issue to be informative and the advice translatable to their own practice.