pudendal neuralgia vs. ilioinguinal neuralgia?

[jonnylingo]

Saw a patient last week with testicular pain so bad, he feels he "wants to cut" his "nuts off". Feels deep ache in groin. Having penis pain as well. No complaint of numbness. Has had prior extensive w/u in Urology including US testicles and STD w/u.

In addition, is having back pain, likely discogenic with pain when coughing, bearing down, forward flexion, and MRI showing L5-S1 annular tear.

Any thoughts?

From what I understand, both pudendal and ilioinguinal neuralgia could present with testicular pain. Would you go forward with pudendal block, ilioinguinal block, epidural at T12-L1?

---

Members don't see this ad.

 

[SSdoc33]

Saw a patient last week with testicular pain so bad, he feels he "wants to cut" his "nuts off". Feels deep ache in groin. Having penis pain as well. No complaint of numbness. Has had prior extensive w/u in Urology including US testicles and STD w/u.

In addition, is having back pain, likely discogenic with pain when coughing, bearing down, forward flexion, and MRI showing L5-S1 annular tear.

Any thoughts?

From what I understand, both pudendal and ilioinguinal neuralgia could present with testicular pain. Would you go forward with pudendal block, ilioinguinal block, epidural at T12-L1?

L5 can cause testicular pain, rand if you have a tear there, theoretically that could be the cause. however, i think its much less likely a spine issue.

also, pudendal neuralgia is almost universally worse with sitting. gotta be one of those 3 sensory penis/testicle nerves

 

[clubdeac]

Do GFN block... if good relief then pulse it. If no relief I would try that on the pudendal and if still no relief then pulse the T12-L2 DRGs. I agree though, L5-S1 disc can cause groin pain....

 

[PinchandBurn]

Saw a patient last week with testicular pain so bad, he feels he "wants to cut" his "nuts off". Feels deep ache in groin. Having penis pain as well. No complaint of numbness. Has had prior extensive w/u in Urology including US testicles and STD w/u.

In addition, is having back pain, likely discogenic with pain when coughing, bearing down, forward flexion, and MRI showing L5-S1 annular tear.

Any thoughts?

From what I understand, both pudendal and ilioinguinal neuralgia could present with testicular pain. Would you go forward with pudendal block, ilioinguinal block, epidural at T12-L1?

I've seen this scenario. Guy had inguinal surgery,etc. everyone thought it was ilioinguinal neuralgia,etc. Including me.

However, long story short. Patient had L5/s1 disc tear like you mentioned. It ended up being the cause of the testicular pain.

Do one diagnostic injection at both,see which one gives patient the best relief....Obviously dont do them together on the same day.

 

[drf]

Agree. GFN and pudendal on separate days. Lower chance of ilioinguinal but could do that third if first two don't help.

 

[Tenesma]

i see this once-twice a year - patients with L5 pathology (usually younger guys - 20s-30s) w/ severe testicle pain...

 

[painstop]

If your injections fail and the pain was concurrent with hernia surgery, consider referral for either mesh removal or "triple neurectomy" (ilioinguinal, iliohypogastric and genitofemoral nerves are isolated and then embedded into muscles...only a few specialists in the country do this type of surgery). Other option is SCS trial but there may be a high likelihood of lead migration.

 

[SSdoc33]

i see this once-twice a year - patients with L5 pathology (usually younger guys - 20s-30s) w/ severe testicle pain...

good point. it is usually in the younger guys.