We read this paper with interest ; we agree that the management of chronic orchialgia is a frustrating problem for both patient and clinician. However, we consider that, along with a good history and clinical examination (including a DRE), ultrasonography of the testes is of paramount importance. This not only helps in reassuring the patient and the clinician in excluding a neoplastic cause, but also detects subclinical varicoceles, hydroceles and epididymal cysts. Antimicrobial therapy, including a quinolone for 6 weeks and a tetracycline for 1 week, should be given, especially if semen analysis reveals much debris or if the prostate is extremely tender, suggesting prostatitis. This may be given with a NSAID for 2 weeks. As the authors mention, the pelvic nerve plexus, in the prostatovesical junction, is involved in chronic orchialgia. These nerves are stimulated in prostatitis, which has a higher incidence in men with high levels of stress. These men would definitely benefit from biofeedback and relaxation techniques, and the use of antidepressants should be withheld until these techniques have had a chance to work and a psychiatrist has evaluated the patient.