Evaluation and Management of Chronic Scrotal Content Pain

Abstract

Chronic scrotal content pain (CSCP) is a common patient complaint which virtually all urologists will encounter in practice. While our understanding of the pathophysiology and management has increased in recent years, CSCP remains a frustrating process for both the patient and physician given that there currently is no standardized protocol for treatment or evaluation. The following article is a literature review regarding the pathophysiology and current medical and surgical options for CSCP. We also provide an updated evaluation and treatment algorithm.

Genital pain: algorithm for management

“…The goal of the operation is to divide all structures that may carry neural fibers but to preserve the arteries (testicular, cremasteric, deferential), several lymphatics to reduce the likelihood of hydrocele, and the vas deferens to prevent obstruction and preserve fertility (15). The rationale of this approach is that by interrupting the neural pathways to and from the scrotal contents, this decreases afferent nerve stimulation and downregulates pain centres (1).…”

“…Levine et al demonstrated at their center a strong correlation between a positive response to a spermatic cord block, defined as >50% temporary reduction of pain, and permanent relief of pain following microsurgical denervation of the spermatic cord (MDSC) (15). Benson et al revealed that men with CO who have a positive response to a spermatic cord block are likely to have durable and complete resolution of symptoms after undergoing MDSC (16).…”

“…Benson et al revealed that men with CO who have a positive response to a spermatic cord block are likely to have durable and complete resolution of symptoms after undergoing MDSC (16). Success rates may vary based on the individual surgeon, and informed consent is critical, as the pain may persist but rarely worsens (15). …”

“…Another long-term study showed a 90% patient satisfaction from epididymectomy in patients with postvasectomy epididymal pain or obstructive pain from previous hernia repair (2). Orchiectomy has been shown to significantly decrease pain in 40–75% if patients (15). …”

Psychological perspectives in the patient with chronic orchialgia

“…In the management and treatment of chronic orchialgia, most patient undergo a comprehensive history and physical, urinalysis and urine culture, and scrotal ultrasound if indicated (2,13,15,16). A variety of symptomatic reliefs, oral medications and other conservatives therapies are then initiated with some providers also recommending surgical treatment or psychological counseling (4,13,17).…”