Contemporary approaches and treatment perspectives for chronic scrotal content pain: insights from a national practice patterns survey of reproductive urologists.

A 25-item electronic survey was circulated to reproductive urologists from around the US to evaluate current national diagnostic and therapeutic practices for the management of chronic scrotal content pain (CSCP). Questions addressed physician demographics, referral patterns, diagnostic protocols, treatment approaches, and outcome perceptions. Forty-one of 183 (22.4%) invited participants completed the survey. Among ten conservative treatment options, reassurance (41.5%) and NSAIDs (31.7%) were most frequently ranked first, while opioid medications were the least preferred, with 56.1% of respondents ranking them last of the ten options. Microsurgical denervation of the spermatic cord was the most commonly utilized surgical procedure overall (95.1%) and the first choice for post-vasectomy pain syndrome (PVPS) in 63.0% of respondents. Vasectomy reversal was the surgery of choice for PVPS in only 22.0% of respondents. Respondents perceived higher complete symptom resolution (median: 75% vs. 25%) and lower failure rates (median: 10% vs. 20%) in patients who had surgery versus those who had only conservative measures. Only 7.3% of participants reported using validated assessment tools such as the Chronic Orchialgia Symptom Index. These results demonstrate that wide variability persists in CSCP management among reproductive urologists, though there is consensus that surgery has a higher success rate as compared to conservative management.