Pain Medicine Ilioinguinal Nerve, Iliohypogastric Nerve, Inguinal Canal, TAP

Chronic scrotal content pain (CSCP) is defined by at least 3 months of chronic or intermittent scrotal content pain with severity that interferes with daily activities, prompting the patient to seek medical treatment . CSCP may originate from the testicle, epididymis, paratesticular structures, and/or the spermatic cord. The etiology of the pain is idiopathic in up to 50% of patients . Easily recognizable and reversible causes include varicocele, epididymitis, spermatocele, tumor, infection, and torsion.
This syndrome has been referred to by many names, including chronic orchialgia, testicular pain syndrome, testialgia, CSCP, post-vasectomy orchialgia, post-vasectomy pain syndrome (PVPS), congestive epididymitis, and chronic testicular pain. Presently, this problem is referred to as CSCP, as this term appears to best encompass the variety of structures that may be involved. Approximately 2.5% of all urology visits are associated with scrotal content pain, resulting in a significant healthcare financial burden . Many patients with this condition end up seeing physicians across many disciplines, further frustrating them.
In recent years, physicians are seeing more patients with CSCP due to the increased awareness of men's health.
Multiple algorithms have been proposed, but none have been validated. It is recommended that pharmacotherapy options should be exhausted before considering surgical treatments, which include epididymectomy, microdenervation of the spermatic cord (MDSC), vasecptomy reversal, and finally orchiectomy. In this article, we aim to review the workup and treatment options available for CSCP.
# Dr Anurag Aggarwal
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