This protocol applies to male patients with chronic scrotal content pain syndrome (CSCP) — unilateral scrotal pain that has persisted for more than three months and continues to interfere with activities of daily living, in whom a prior course of conservative management did not achieve adequate pain control.
Unilateral scrotal pain interfering with activities of daily living, persisting for greater than three months — meeting the established definition of CSCP (also called chronic orchialgia or chronic testicular pain). The absence of other pelvic pain sites or urinary symptoms supports this diagnosis.
Multimodal conservative management was the first-line approach. It did not achieve the goals of scrotal pain reduction and improvement in quality of life, triggering escalation to the next treatment step described in this protocol.
For patients who have not responded to conservative management, the evidence-based pathway includes targeted surgical options — the choice of procedure is guided by the anatomical location of maximal tenderness — with inguinal orchiectomy reserved strictly as a last resort. Where surgery is insufficient or not indicated, referral to a pain management specialist for advanced interventional options is part of the structured approach.
The complete regimen, decision criteria, sequencing, and full list of interventions are available in the full protocol.
Treatment goal: Scrotal pain resolution or significant reduction.
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.
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.
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).
Orchiectomy should be considered a treatment of last resort when pain has proven refractory to less invasive treatments for CSCP.
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