What Can We Do for Chronic Scrotal Content Pain?

Abstract

Chronic scrotal content pain remains one of the more challenging urological problems to manage. This is a frustrating disorder to diagnose and effectively treat for both the patient and clinician, as no universally accepted treatment guidelines exist. Many patients with this condition end up seeing physicians across many disciplines, further frustrating them. The pathogenesis is not clearly understood, and the treatment ultimately depends on the etiology of the problem. This article reviews the current understanding of chronic scrotal content pain, focusing on the diagnostic work-up and treatment options.

Keywords: Chronic pain; Epididymis; Epididymitis; Pelvic pain; Vasovasostomy.

Fig. 1. Diagnosis and treatment algorithm for chronic scrotal content pain. NSAIDs: non-steroidal anti-inflammatory drugs, CT: computed tomography, MRI: magnetic resonance imaging, A/P: abdomen or pelvis.

Fig. 2. Microdenervation of the spermatic cord. (A) Marking of inguinal site. (B) Dissection to expose the spermatic cord. (C) Spermatic cord supported by a Penrose drain with the cord fascia opened. (D) Arteries secured by a vessel loop. (E) After completion of the dissection, only the cremasteric artery, testicular artery, deferential artery, and lymphatics remain (top to bottom).