Chronic scrotal content pain (CSCP) — also referred to as chronic testicular pain or chronic orchialgia — is unilateral scrotal pain that interferes with activities of daily living and has persisted for more than three months. The diagnosis is reached after excluding other potential causes, including testicular torsion, epididymitis, orchitis, abscess, testicular mass, and varicocele.
Clinicians should consider CSCP in patients with unilateral chronic scrotal pain in the absence of other pelvic sites of pain or urinary symptoms.
Conservative multimodal therapy — encompassing lifestyle modification, pharmacologic pain management, targeted nerve blocks, and related procedures — did not achieve the expected reduction in scrotal pain or meaningful improvement in quality of life.
This protocol addresses the next step for patients in whom that first-line approach has been insufficient.
When conservative measures have not produced adequate relief, the subsequent approach involves surgical and specialist interventional options, with selection guided by the anatomical distribution and character of the pain. The treatment goals are resolution or significant reduction of scrotal pain and restoration of quality of life.
The complete structured protocol — including specific procedural criteria, sequencing, and additional specialist referral pathways — is available via the link below.
DOI: 10.1097/JU.0000000000004564
CSCP or chronic testicular pain or chronic orchialgia is defined as unilateral scrotal pain interfering with activities of daily living that has persisted for greater than three months of time.
CSCP is usually diagnosed after excluding other potential causes (e.g., testicular torsion, epididymitis, orchitis, abscess, testicular mass, varicocele).
Clinicians should consider the diagnosis of CSCP in patients who experienced unilateral chronic scrotal pain in the absence of other pelvic sites of pain or urinary symptoms.
Clinicians may offer epididymectomy to patients with pain and tenderness focal to the epididymis after failure of conservative therapies.
Clinicians may offer inguinal (not scrotal) orchiectomy with removal of the entire spermatic cord for patients with CSCP.
Orchiectomy should be considered a treatment of last resort when pain has proven refractory to less invasive treatments for CSCP.
If all treatment options fail and the CSCP patient is still suffering from pain, clinicians may discuss consultation with a pain management specialist for further options (e.g., neuromodulation, neurostimulators, spinal blocks).
A majority (80%) of these patients reporting complete pain resolution following the procedure.
Overall success (resolution of pain) ranges from 20% to 75%.
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