Post-Nephrectomy Orchialgia: A Cross-Sectional Assessment of an Underreported Complication in Living Kidney Donors

Background/Objectives: Orchialgia following kidney donation is an underrecognized complication with reported incidence varying dramatically between retrospective (2–3%) and prospective (44–55%) studies, suggesting significant underreporting. This study aimed to determine the incidence, characteristics, and clinical relevance of orchialgia in male kidney donors within 2 years post-donation using direct patient assessment. Methods: This is a cross-sectional study of 100 male donors (64.5% response rate) from 155 eligible donors approached who underwent left laparoscopic donor nephrectomy between February 2021 and 2023. Donors completed a literature-based 15-item questionnaire at routine follow-up visits assessing testicular pain characteristics, timing, and impact. Results: Orchialgia occurred in 48% (48/100) of donors. Early onset (≤14 days) occurred in 47%, with median onset at day 2 (range 1–14). At 3-month follow-up, 37% reported persistent pain; by 1 year, only 0.8% experienced persistent pain based on our 10-year institutional database. No significant difference in incidence between altruistic (54%) and related donors (33%), though pain severity was lower in altruistic donors (mean 3.6 vs. 4.2, p = 0.04, independent t-test). Conservative management was effective in all cases; no invasive interventions were required. Conclusions: Orchialgia affects nearly half of male kidney donors when directly assessed, though it follows a benign, self-limiting course with minimal long-term clinical impact. These findings support enhanced preoperative counseling while reassuring donors about favorable outcomes.