(319) Spermatic Cord Block for Chronic Scrotal Pain

Introduction Chronic scrotal pain (CSP) is defined as bothersome pain localized to structures within the scrotum for ≥ 3 months accompanied by significant negative effects on an individual’s quality of life (Ziegelmann et al., 2019). CSP encompasses pain radiating to the perineum, lower abdomen/suprapubic area, testes, or penis - all of which may occur during ejaculation or urination and thus, are often associated with sexual dysfunction and ED (AUA Guidelines, 2025). Etiologies of chronic scrotal pain include infections, testicular torsion, inflammation and nerve irritation from post-vasectomy pain syndrome (PVPS), or post-inguinal hernia repair pain (PIHRP) (Aljumaily et al., 2017). Prior studies have established that the genital branch of the genitofemoral nerve in the spermatic cord and ilioinguinal nerve in the inguinal canal play a significant role in the manifestation of scrotal pain (AUA Guidelines, 2025). Objective For patients with primary chronic scrotal content pain without improvement with pharmacological or behavioral therapies, clinicians should consider spermatic cord block (SCB) administration (AUA Guidelines, 2025). This video highlights relevant clinical evaluation and management for chronic scrotal pain, with a focus on spermatic cord block. Methods An injection of 8 mL of 2.0% lidocaine 1 cm inferior and medial to the pubic tubercle, circumferentially around the vas deferens, can be both diagnostic and therapeutic. Patients reporting more than a 50% temporary pain improvement can be offered microscopic denervation of the spermatic cord (Beamer et al., 2021). Some studies show significant pain improvement with denervation procedure even when there is minimal pain improvement with spermatic cord block (Oomen et al., 2014). Otherwise, blocks can be repeated as needed as ongoing management. Results Some studies show significant pain improvement with denervation procedure even when there is minimal pain improvement with spermatic cord block (Oomen et al., 2014). Otherwise, blocks can be repeated as needed as ongoing management. Conclusions Although SCB is a known, less-invasive alternative to more invasive procedures such as epididymectomies or inguinal orchiectomies with cord removal, patients still visit an average of five different providers prior to receiving a SCB, urging the need for further clinician education on SCB (Ziegelmann et al., 2019). Disclosure No