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Validation of the chronic orchialgia symptom index for symptom severity and responsiveness to therapy

Shoskes, D1; Calixte, N2; Tadros, N1; Li, J1; Parekattil, S2

1: Cleveland Clinic, United States; 2: PUR Clinic, United States

Objectives: Chronic orchialgia, pain > 3 months of the scrotal contents in the absence of demonstrable testicular pathology is poorly understood and understudied given its prevalence. One limitation is the absence of a validated symptom score to accurately capture symptom severity and response to therapy. We created the Chronic Orchialgia Symptom Index (COSI) based on patient reported symptoms and impact which has 11 questions (total score 0-37) in 3 domains (pain, sexual dysfunction (SD) and quality of life(QOL)). We wished to validate the COSI in a prospective cohort of patients.

Methods: The COSI was given to 170 men with documented chronic orchialgia at 2 institutions. 78 men repeated the COSI between 3 and 7 days later before starting therapy and 42 repeated the COSI after surgical therapy. Data was analysed for test/retest internal reliability, internal consistency, floor/ceiling effects, construct validity, responsiveness and linear regression of all questions including age, duration and prior surgeries.

Results: The 170 men had a mean age of 43.4 (range 18-82) and median symptom duration of 24 months (3-420). 22.4% had prior vasectomy, 12.4% had ipsilateral hernia repair and 12.9% had other prior surgery. Mean total COSI was 20.0+/-7.7 (range 1-37) with subscores of pain 9.1 +/-3.5 (0-17), SD 1.82 +/-1.5 (0-5) and QOL 9.0+/-4.0 (0-15). Test/retest reliability was high with mean retest total score of 21.2+/-7.9 and intraclass correlation coefficient of 0.82 (>0.7 considered valid). Internal consistency by Cronbach’s alpha was 0.86 (>0.7 considered consistent). There were no floor/ceiling effects for total score but SD had 25.6% at floor. Construct validity showed all COSI items were a good model fit (p=0.001). Linear regression showed each item was significant but age, duration and prior surgeries were not. Finally, the COSI was responsive to symptom improvement after therapy (total 13.5+/- 9.8, p=0.00001).

Conclusion: COSI is a valid symptom index to assess severity of symptoms and response to therapy in this challenging patient population.


Work supported by industry: no. The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

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