title: Chronic scrotal pain syndrome: management among urologists in Switzerland.
abstract: OBJECTIVE
  Management of patients presenting with chronic or recurrent pain located in the scrotum is often very challenging. Evidence-based literature and clinical practice guidelines for the management of chronic scrotal pain syndrome (CSPS) are not available. We assessed the current perception and management of chronic scrotal pain syndrome by urologists in Switzerland.
  
  
  METHODS
  In July 2004, all the members of the Swiss Society of Urology received a questionnaire focusing on diagnostic and treatment practices for the management of chronic scrotal pain syndrome. The questionnaire consisted of 6 topics concerning practice setting, incidence, aetiology, diagnostics, therapy and treatment success rate.
  
  
  RESULTS
  103 questionnaires were completed (63%). All but 2 (2%) responding Swiss urologists see a mean of 6.5 new patients per month (range 1-30). 79% of Swiss urologists consider CSPS to be infectious or post-infectious in nature. Furthermore, a history of vasectomy, psychosomatic disorders, chronic prostatitis, neuromuscular disorders, a history of inguinal surgery, and idiopathic aetiology were mentioned in decreasing order. The most commonly used examinations are urinalysis in 96% and ultrasound in 93%. Additional assessments include blood sampling, duplex ultrasound, assessment for coexisting chronic prostatitis, and referral to an Orthopaedist, Rheumatologist or Psychiatrist. The predominant medication prescribed for CSPS is a non-steroidal anti-inflammatory agent given for a mean of 15.5 days. An antibiotic trial is prescribed by 82% for a mean of 20.5 days. 74% consider epididymectomy the treatment option of choice in recurrence. Inguinal orchiectomy is performed by 7%, microsurgical spermatic cord denervation is performed by 6% of surgeons. Mean estimated recurrence rate after conservative treatment is 48% and thus higher than after epididymectomy with 18%.
  
  
  CONCLUSIONS
  Chronic pain located in the scrotum is a common clinical condition in Switzerland. Most urologists consider an infection or post-infectious alterations as the predominant aetiology for CSPS. Consequently, an antibiotic trial in combination with an anti-inflammatory agent is prescribed as first-line therapy. Recurrence rates for conservative treatment are estimated high which is in contradiction to the presumed aetiology. Therefore, further evaluation of this poorly described disease complex is required.
authors.affiliation: Department of Urology, University Hospital Zurich, Frauenklinikstr. 10, 8091 Zurich, Switzerland. raeto.strebel@usz.ch
authors.forename: Raeto T
authors.initials: RT
authors.lastname: Strebel
authors.forename: Thomas
authors.initials: T
authors.lastname: Leippold
authors.forename: Thomas
authors.initials: T
authors.lastname: Luginbuehl
authors.forename: Michael
authors.initials: M
authors.lastname: Muentener
authors.forename: Valentin
authors.initials: V
authors.lastname: Praz
authors.forename: Dieter
authors.initials: D
authors.lastname: Hauri
mesh_terms: D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D002908:Chronic Disease; D003937:Diagnosis, Differential; D005832:Genital Diseases, Male / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D008297:Male; D009919:Orchiectomy; D010147:Pain Measurement / Q000379:methods*; D017699:Pelvic Pain / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D012008:Recurrence; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012611:Scrotum; D012720:Severity of Illness Index; D012955:Societies, Medical; D011795:Surveys and Questionnaires; D013557:Switzerland; D014572:Urology; D014659:Vasectomy
chemical_list: D000893:Anti-Inflammatory Agents