(111) Spermatic Cord Block as a Treatment Modality in Chronic Scrotal Pain: A Tertiary Referral Center Study

Introduction Chronic scrotal pain (CSP) is a multifactorial and often idiopathic condition that significantly affects quality of life in men. Treatment algorithms remain undefined, and conservative therapies are frequently ineffective. Objective The aim of this study was to characterize the clinical profile of men with CSP and to evaluate therapeutic responses to spermatic cord block with local anesthesia at a tertiary referral center. Methods We retrospectively assessed data from 30 men with CSP who underwent spermatic cord block injections between 2019 and 2024 at a single academic institution. Exclusion criteria included previous vasectomy. Demographic and clinical variables, pain characteristics, treatment response, number of injections, complications, and use of adjunctive therapies were systematically recorded. Results Patients had a median age of 50 years (SD: 14.2); 18 (60%) had a history of pelvic or genital surgery, notably 8 men (44.4%) underwent inguinal hernioplasty and 6 (33.3%) varicocelectomy. CSP was unilateral in 26 men (86.7%) and bilateral in 4 patients (13.3%), with an initial mean VAS of 5.6 (SD: 2.2). The average duration of pain before treatment was 32.8 months (SD: 40.2). A total of 76 injections were administered, with a median of 3 injections per patient (SD: 1.4), ranging from 1 to 7, and a mean interval between injections of 56.4 days (SD: 102.8). After the first injection, 25 (83.3%) of patients reported pain improvement with a mean VAS reduction to 2.4 (SD: 2.5). 17 patients (58.6%) initially experienced pain relief following the injection, but their pain returned to baseline levels after a few hours. At the end of the treatment, 11 men (38%) reported complete pain resolution, 9 (31%) partial improvement, and 9 (31%) no improvement, with a mean final VAS of 2.5 (SD: 2.6). Complications included spermatic cord hematoma in 3 (10%) of cases. 7 patients (24%) who failed to respond to treatment were referred for specialized pain management, and 4 patients (13.4%) underwent microsurgical denervation, with 3 (75%) of these achieving complete pain resolution. Conclusions Spermatic cord block is a moderately effective and low-risk intervention for CSP in selected patients, particularly those who do not respond to conservative therapy and lack identifiable organic causes. Disclosure No