Mr. Gong’s left testicle has been vaguely painful recently, especially after driving for a long time. He thought it was the aftermath of the accidental collision caused by playing soccer two weeks ago, and that he could get better with some rest. However, after nearly two months, the pain is still intermittent. The more he thought about it, the more he searched for information on the Internet, but unexpectedly found many people with the same question. But how the pain occurred, but the Internet says different, Mr. Gong is more apprehensive. The reporter interviewed the first hospital of Sun Yat-sen University urology professor Tu ringan. He said that the factors causing testicular pain can be grouped into six categories, and a clear diagnosis of the cause can be made through urological ultrasound and CT and MRI examinations. In addition to this, there are 25-50% of testicular pain that cannot find any cause and are called idiopathic testicular pain. There are seven possibilities for testicular pain Tu Rangan said that most people refer to testicular pain in medical terms as chronic testicular pain, which is manifested as persistent or intermittent unilateral or bilateral testicular pain for more than 3 months, with vague pain or swelling, and has a certain impact on the patient’s quality of life. From the clinical point of view, the definite factors causing testicular pain can be summarized into 6 major categories. First, testicular lesions: 1, testicular inflammation, with redness, swelling and heat pain; 2, testicular tumors, which can be felt as swelling and hard lumps at the testicles; 3, testicular torsion, often manifested as sudden and severe testicular pain at night in bed, which cannot be relieved; 4, testicular trauma, which forms scars after wound healing and pulls the testicles can also cause pain. Second, epididymal (mostly located outside the rear of the testicle) lesions: 1, inflammation of the epididymis, symptoms are the same as orchitis; 2, epididymal cyst, a small soft round swelling can be felt in the epididymis; 3, epididymal sludge or epididymal granuloma, caused by vasectomy leading to semen drainage, manifested as swelling of the head of the epididymis, painful to touch; 4, epididymal tumor, but the incidence is extremely low. Thirdly, vasectomy. Testicular pain will occur in 15-19% of people after ligation, some because of neuroma formation and some because of spermatogonial granuloma. Fourth, lesions of the spermatic cord (which is connected to the tail of the epididymis and exists in the scrotum and groin), mostly caused by varicose veins in the spermatic cord, often manifesting as vague pain and swelling in the testicles, and the pain will increase after standing for a long time or exertion. Fifth, urinary system diseases, such as prostatic hyperplasia, prostatitis, urethral stricture, urinary stones, especially lower ureteral stones, and scrotal sheath effusion. Sixth, factors outside the genitourinary system, such as hernia, radiculitis of the spine, lumbar disc herniation, and irritable bowel syndrome. Patients with psychological problems such as anxiety and depression also have a high possibility of inducing testicular pain. In addition, according to foreign reports, 25%-50% of testicular pain cannot be found for any reason, and this is called idiopathic testicular pain, and most patients have some psychological problems. Evaluation and diagnosis of testicular pain Doctors usually evaluate the pain in four ways. Firstly, the nature of the pain, except for acute inflammation or testicular torsion which can lead to severe pain, chronic testicular pain usually manifests as hidden pain, swelling, dull pain or pins and needles pain, severe pain is rare, if suffering from stones or lumbar disc herniation, it can be combined with involvement pain in the buttocks, inner and outer thighs, etc.; secondly, in terms of duration, if the patient cannot sit for a long time, sitting for a period of time is very uncomfortable, and at the same time combined with discomfort in urination, etc. The pain is mostly unilateral testicular pain, and testicular pain caused by varicocele is more common in the left testicle, but there is also a considerable part of bilateral testicular pain; finally, the excitation point of the pain is also instructive to identify what kind of pain. For example, testicular pain after standing for a long time or exertion may be related to varicocele; testicular pain after standing or sitting for a long time may be caused by excessive pressure on the lumbar spine and herniated discs. It is not difficult to diagnose testicular pain; a meticulous history, physical examination and routine urinalysis and a detailed urological ultrasound (kidney, ureter, bladder, prostate and scrotum should all be looked at) will usually give the answer. However, if the pain is considered to be related to a spine-related lesion, a CT or MRI is also needed in conjunction. Treatment and prevention of testicular pain Tu said that testicular pain that can find a clear cause can be treated by removing the cause, but there are some patients who cannot find the cause of the pain, and for this type of idiopathic testicular pain, most hospitals in China use medication. After three months of medication, 60%-65% of the patients can relieve or reduce the pain. However, the long-term application of drugs can also bring the side effects of drug tolerance and deteriorating efficacy. To reduce side effects, a minimally invasive procedure of microdenervation of the spermatic cord under a microscope can also be used. This technique was carried out by Professor Devine of the Medical College of Virginia in 1978 and is now recommended by Campbell Urology, the world’s most authoritative urological monograph.