Treatment of Chronic Pelvic Pain Syndrome in Men with Persistent Localised Scrotal Pain
This protocol applies to male patients with chronic pelvic pain syndrome presenting as persistent or recurrent episodic pain localised to the scrotum or its internal structures, where no infection or other identifiable local pathology has been established and symptoms have been present for at least three months.
Clinical Scenario
- Male sex
- Persistent or recurrent episodic pain localised to the scrotum or structures within it
- No proven infection or other obvious local pathology
- Pain duration of at least 3 months
Primary scrotal pain syndrome is the occurrence of persistent or recurrent episodic pain localised to the scrotum or the structures within it and may be associated with symptoms suggestive of lower urinary tract or sexual dysfunction. By definition, no proven infection or other obvious local pathology accounts for the pain.
Treatment Approach
For this population, the structured regimen includes a microsurgical approach targeting the spermatic cord — patient eligibility and the specific procedure used depend on individual clinical factors assessed prior to intervention. The complete evidence-based algorithm, including selection criteria and procedural alternatives, is available in the full protocol.
Treatment Goal
Goal
Resolution or reduction of chronic scrotal pain.
References
- Primary scrotal pain syndrome is the occurrence of persistent or recurrent episodic pain localised to the scrotum or the structure within it and may be associated with symptoms suggestive of LUT or sexual dysfunction.
- There is no proven infection or other obvious local pathology.
- In patients with testicular pain improving after spermatic block, offer microsurgical denervation of the spermatic cord.
- Microsurgical denervation of the spermatic cord is an effective therapy for primary scrotal pain syndrome.
- For scrotal pain post-vasectomy, affected males may find that reversal of the vasectomy can cure symptoms, especially in those in whom patency is achieved.
- Vasovasostomy is effective in post-vasectomy pain.
View source ↗