Background: Chronic scrotal content pain (CSCP) is a devastating condition characterized by localized scrotal pain that persists for ≥ 3 months and interferes with daily activities. Approximately 2.5% of all urology outpatient visits are associated with CSCP. General urologists may have difficulty treating these patients because of uncertainties regarding the etiology and pathophysiology of CSCP. Therefore, we aimed to provide a simplified diagnostic and treatment approach for CSCP by subdividing it into distinct categories.
Materials and methods: We systematically reviewed the published literature in the PubMed, MEDLINE, and Cochrane databases for all reports on CSCP diagnosis and treatment using the keywords “chronic scrotal content pain,” “testicular pain,” “orchialgia,” “testicular pain syndrome,” “microdenervation of the spermatic cord,” “post-vasectomy pain syndrome,” “post-inguinal hernia repair pain,” “testialgia,” and “pudendal neuralgia.” This review included only CSCP-related articles published in English language.
Results: We subdivided CSCP syndrome into 5 clinical presentation types, including hyperactive cremasteric reflex, pain localized in the testicles, pain in the testis, spermatic cord, and groin, pain localized in the testicles, spermatic cord, groin, and pubis, and pain in the testicles, spermatic cord/groin, and penis/pelvis. Treatments were adjusted stepwise for each type and section. We included more information regarding the role of pudendal neuroglia in CSCP syndrome and discussed more options for nerve blocks for CSCP. For microsurgical spermatic cord denervation failure, we included treatment options for salvage ultrasound-guided targeted cryoablation, Botox injections, and posterior-inferior scrotal denervation.
Conclusions: Different CSCP subtypes could help general urologists assess the appropriate diagnostic and treatment approaches for scrotal pain management in daily practice.
Acknowledgments
None.
Statement of ethics
Not applicable.
Conflict of interest statement
No conflict of interest has been declared by the author.
Funding source
None.
Author contributions
SK, SJP: conceived and designed the classification and treatment algorithm;SK: collected the data and wrote the paper;GB: contributed to the design and implementation of the subclassification and treatment algorithm;MRB: literature search and graphic design;RM: made a substantial contribution to the concept and design of the article;DS: took the lead in writing and correction of the manuscript;JCN: drafted the article and revised it critically and approved the version to be published.
Data availability
The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
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