Chronic Scrotal Content Pain (CSCP) Syndrome significantly impacts patients’ daily lives and quality of life, accounting for approximately 2.5-4.8% of all urology outpatient visits and affecting over 100,000 men annually. Nearly half of CSCP cases have idiopathic origins, and any condition affecting nerves along pathways from T10-L2 and S2-S4 can refer pain to the inguinal-scrotal region. Due to the complex nature of CSCP, general urologists often feel unprepared to treat it effectively, leading patients to consult an average of 4.5 physicians and undergo multiple diagnostic tests before finding relief. Currently, multiple treatment algorithms for CSCP exist without a unified consensus, complicating effective diagnosis and treatment. This study aimed to simplify the treatment approach, creating an accessible algorithm to guide general urologists in CSCP management.
Using a comprehensive literature review of CSCP diagnosis and treatment from PubMed, Medline, and Cochrane databases, we redefined CSCP into five clinical presentation types: hyperactive cremasteric reflex; pain limited to the testicle; pain in the testis, spermatic cord, and groin; pain spanning the testicle, spermatic cord, groin, and pubis; and pain in the testicle, spermatic cord, groin, and extending to the penis or pelvis. Treatment steps were tailored to each type, with particular attention to the role of pudendal neuroglia in CSCP. Treatment options included expanded nerve block procedures, microsurgical spermatic cord denervation (MSCD), and, for MSCD failures, new interventions such as ultrasound-guided targeted cryoablation, Botox injections, and posterior-inferior scrotal denervation.
The study’s findings led to a new diagnostic and treatment algorithm tailored to each form of scrotal pain, helping urologists focus on specific types of CSCP and simplifying stepwise treatment processes. This refined classification system could provide general urologists with a structured pathway for diagnosing and managing CSCP effectively, potentially improving patient outcomes and reducing the need for prolonged, repetitive consultations.
