736 LAPAROSCOPIC TESTICUIAR DENERVATION

encompass these patients (reference 4 in article). Specialists in phys- ical medicine and rehabilitation are familiar with this disorder but the overwhelming number of practicing urologists are not. Physical therapy may have an important role in the management of some of these conditions.

We have adopted a systematic multidisciplinary approach for the management of chronic genital pain. Patients are evaluated and treated by a urologist, mental health professional and physical ther- apist. Although it is too early to know the outcome of this approach, initial experience is promising. Because of the limitations in this report, we do not advocate the general use of testicular denervation for the management of chronic unexplained genital pain. Alterna- tively, we encourage others to adopt a multidisciplinary approach in the evaluation and management of this complex disorder.

Elroy D. Kursch Department of Urology-Lynhurst Cleveland Clinic Foundation Lynhurst, Ohio

1. sin&, M., Merritt, J. L. and Stillwell, G. K.: Tension myalgia of the pelvic floor. Mayo Clii. Proc., 52 717, 1997.

REPLY BY AUTHORS

Chronic orchalgia is a common and perplexing problem for the urologist. It is especially frustrating since many of these patients present with pain following other (nonpain related) urological pro- cedures such as vasectomy. All patients were offered pain clinic referral and treatment either failed or was refused when they were informed of therapies offered. In addition, all patients were seen multiple times by the same urologist who eventually performed the procedure. The evaluation process permitted the development of a good rapport with the patient and an opportunity for the surgeon screen for other psychological factors. The best evaluation of this procedure would be a blinded study but this would be difficult to perform in the given scenario.