Introduction

Chronic pelvic pain and orchalgia are challenging conditions to treat in urologic practice. Recent research and treatment have begun to focus on musculoskeletal dysfunction as a major contributor to pelvic pain and orchalgia. The objective of this study is to assess the clinically reported outcomes of patients in our center that presented with orchalgia who underwent physical therapy._x000D_

Methods

A retrospective chart review was conducted on men who initially presented to our practice with orchalgia from January 2009 to June 2016 and referred for pelvic floor physical therapy. Each patient had a urologic assessment prior to physical therapy referral. Patients were evaluated and treated by our physical therapy team according to any presenting musculoskeletal impairments/complaints. Treatments included pelvic alignment exercises, therapeutic stretching/strengthening, manual therapy, dry needling and biofeedback. Following treatment, a subjective global response measure was assessed based on patients&[prime] self-reports of improvement. Additionally, if available, NIH Chronic Prostatitis Symptom Index (NIH-CPSI) data was collected. Statistical analysis was performed in SAS 9.4 (SAS Institute, Cary, NC) where all P-values less than 0.05 were considered statistically significant.

Results

A total of 392 patient charts met inclusion criteria for this retrospective study. Average age was 42.8 years with mean longevity of symptoms of 32.8 months. 49.1% had co-existing urinary complaints. Pre-treatment average day pain was 4.5 (analog scale 1-10); worst day pain was 7.6. 83.2% of patients indicated their testicular pain was better, 16.1% reported no change and 0.7% reported worsening of their pain at average follow up of 6.4 months. 150 patients (38%) completed a NIH-CPSI questionnaire both pre and post treatment. Of these patients, those who reported improvement in their pain (n=138) had decrease in pain scores from average of 16.7 to 11.3, decrease in urinary score from 2.6 to 2.0, and improvement in quality of life score from 8.1 to 4.2; each was statistically significant (p<0.01). Patients who did not improve or had worsening of symptoms with physical therapy (n=12) did not have statistically significant improvement in pain, urinary or quality of life scores (p=0.36, p=0.78, p=0.17; respectively).

Conclusions

Physical therapy serves as a valid and effective treatment option for patients with orchalgia, following a comprehensive urologic examination. The significant subjective and objective improvement reported by this group of patients with no adverse side effects points towards early referral to a pelvic physical therapy practice.

Funding

none