[Therapeutic management of chronic intrascrotal pain]

To resume available therapeutic options for intra scrotal chronic pain, including surgical procedures, and to analyze their efficiency through a review of published data.

Review of articles published on this topic in the Medline (PubMed) database, selected according to their scientific relevance.

Initial treatment of epididydimal and testicular pain should always be conservative. Mean success rates of the different therapeutic options varies from 27% to 90%. Surgery on the scrotal content should be considered only if: (1) Pain can be explained by a local intra scrotal cause; (2) Medical and conservative treatments have failed; (3) Nerve block has been tried and is efficient in relieving pain; (4) Patients are informed of the risk of failure. Conservative surgical procedure (epididymectomy, vasovasostomy) have a success rate of 50-70%. Microsurgical spermatic cord denervation yields better results, while preserving testis and epididymis integrity. Failure is still possible (15%). Orchidectomy should be avoided if possible.

Levels of evidence concerning indications and efficiency of these surgical procedures are low. Patients suffering from recurring or implacable chronic testicular and epididymal pain require a multidisciplinary care.