90-minute nerve surgery gives men relief from constant testicular pain

‘It’s a more common problem than most people realize,’ says UCLA Health’s Dr. Jesse Mills.

Most men know what it is like to feel testicular pain at some point. It can be debilitating, but brief.

A variety of ailments, however, can cause some men to feel extreme testicular pain long term, affecting every moment of their lives.

The good news is that UCLA urological surgeons have various methods to cure these conditions, usually nerve-related, and give these men their lives back.

Surgeons at UCLA Health often can solve complicated problems causing extreme testicular pain in a 90-minute surgery that allows the patient to go home that same day.

"Testicular pain can affect anyone, of any age," said Sriram Eleswarapu, MD, PhD, noting that he has had patients in their 20s and in their 80s who were experiencing testicular pain.

"There are patients who have been struggling with this for years and years," Dr. Eleswarapu said. "So one of the things that we try to do at UCLA is expand our outreach and let primary care practices and other urologists know that, if you have these guys who are having unrelenting testicular pain, and you can't figure out the cause – send them to us. We may be able to help."

Sometimes men are at first reluctant to talk about testicular pain, even with a doctor. But when they come to UCLA, it's because the pain has become a problem that cannot be ignored, says Dr. Eleswarapu's surgical partner, Jesse Mills, M.D., clinical professor and division chief of andrology at UCLA.

"It’s hard to imagine living with hurting chronically anywhere, but especially when you’re hurting in the testicle," Dr. Mills said. "It’s just a terrible feeling all the time. It gets in the way of everything, from just sitting, to working, to athletics, to sex and all the stuff that makes us human.

Dr. Siriam Eleswarapu

"It’s a more common problem than most people realize," Dr. Mills said.

Constant pain for a year

Robert Falletta knows all too well about this roller coaster ride of pain. He suffered serious testicular pain for about a year.

Trips to several doctors for the Thousand Oaks resident meant prescriptions for antibiotics under the assumption that he simply had a common bacterial infection called epididymitis.

His pain persisted until he came to UCLA Medical Center and Drs. Mills and Eleswarapu. An ultrasound showed that Falletta's spermatic cord, a bundle of blood vessels and nerves that nourish the testicles, had evidence of severe inflammation and potential degeneration.

Dr. Jesse Mills

"I was really in excruciating pain," Falletta said. "I mean, it was very, very painful. It was all-encompassing."

Even strong pain medicine only gave Falletta limited relief.

Before his surgery at UCLA, Falletta had stopped exercising and dropped from 150 pounds to 130 in one month because of nausea killing his appetite.

Performing surgery under a microscope, Dr. Eleswarapu cleaned up Falletta's inflamed spermatic cord and carefully treated the nerves that were causing so much pain – a process called "microsurgical spermatic cord denervation."

In July, Falletta celebrated the one-year anniversary of his successful 2020 surgery by calling Dr. Eleswarapu to thank him again.

"Dr. Eleswarapu deserves 10 stars out of five for my surgery," said Falletta, who is back at his ideal weight and living pain-free.

"I mean, it was something that literally saved my life. I was in such terrible condition with the pain that I just don't know what I would have done without the surgery," Falletta said.

A new life

Dr. Eleswarapu said life-changing outcomes such as this are what makes his profession so satisfying.

"It's really gratifying to see a 180-degree change from someone who's truly miserable to being completely liberated from pain," Dr. Eleswarapu said.

"The reason we get into medicine is to cure people of their ailments," he said. "But there's not always a cure for everything. So when we can do something that is truly curative, it's extremely rewarding."

There are many causes of testicular pain, from infections to urinary problems to orthopedic issues with the pelvis, hip or knees. But it often comes down to nerve issues with the scrotum or testicles, as was the case with Falletta.

That's when it helps to see a top specialist using the latest technology to find and solve the problem.

"That's why people come to us at UCLA," Dr. Eleswarapu said. "They expect state-of-the-art treatment."

Dr. Mills said they first determine if surgery is appropriate, by ruling out all other possibilities for the pain. He added that many men are understandably hesitant to have surgery in that sensitive area.

"But there comes that point, where you are dealing with that kind of pain, and ask yourself, do you want to live like this for the rest of your life?" Dr. Mills said. "So, right, if there’s a surgical option that gives men a reasonable chance of success, then they are ready to do it."

To learn more, visit The Men's Clinic at UCLA.

Tina Daunt is the author of this article.