title: Successful treatment for patients with chronic orchialgia following inguinal hernia repair by means of meshoma removal, orchiectomy and triple-neurectomy.
abstract: BACKGROUND
  Orchialgia following inguinal hernia repair is rare complication and still challenging since there has been no established surgical treatment because of complexity of nerve innervation to the testicular area. Herein we report a case of postoperative orchialgia following Lichtenstein repair, which was successfully treated by mesh removal, orchiectomy and triple neurectomy.
  
  
  METHODS
  A 65-year-old man was referred to our department because of chronic right orchialgia following Lichtenstein hernia repair. He walked with a limp and was unable to walk a long distance. Physical examination revealed the presence of meshoma in the groin area and hypoesthesia in the anterior skin of the right scrotum. His right testis was completely atrophic and located not in the scrotum but in the subcutaneous regions of right groin. He was diagnosed as both neuropathic and nociceptive orchialgia and underwent meshoma removal, triple-neurectomy, and orchiectomy to address these issues. Pathological examination revealed that meshoma was integrated with the structures of the spermatic cord, leading to foreign-body reaction and fibrosis around the genital branch of genitofemoral nerve. The resected right testis was completely-scarred without ischemic changes. Orchialgia disappeared immediately after operation and he was able to walk without a limp.
  
  
  CONCLUSIONS
  It is important to distinguish between nociceptive and neuropathic orchialgia. Neuroanatomic understanding is essential to guide treatment options. Orchiectomy is an option but should be reserved for refractory cases with evidence of nociceptive pain accompanied by anatomical changes.
  
  
  CONCLUSIONS
  Triple neurectomy should be considered in patients with neuropathic orchialgia.
authors.affiliation: Department of Surgery, National Hospital Organization, Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan. Electronic address: narinari@kuhp.kyoto-u.ac.jp.
authors.forename: Masato
authors.initials: M
authors.lastname: Narita
authors.affiliation: Department of Pathology, National Hospital Organization, Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan.
authors.forename: Koki
authors.initials: K
authors.lastname: Moriyoshi
authors.affiliation: Department of Surgery, National Hospital Organization, Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan.
authors.forename: Keita
authors.initials: K
authors.lastname: Hanada
authors.affiliation: Department of Surgery, National Hospital Organization, Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan.
authors.forename: Ryo
authors.initials: R
authors.lastname: Matsusue
authors.affiliation: Department of Surgery, National Hospital Organization, Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Hata
authors.affiliation: Department of Surgery, National Hospital Organization, Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Yamaguchi
authors.affiliation: Department of Surgery, National Hospital Organization, Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan.
authors.forename: Tetsushi
authors.initials: T
authors.lastname: Otani
authors.affiliation: Department of Surgery, National Hospital Organization, Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan.
authors.forename: Iwao
authors.initials: I
authors.lastname: Ikai
keywords: Genital branch of genitofemoral nerve; Ilioinguinal nerve; Neuropathic pain; Nociceptive pain; Testicular atrophy; Testicular pain