Introduction:
Chronic scrotal pain or chronic orchialgia , one of the most vexing urologic conditions, is defined as persistent or recurrent episodic unilateral or bilateral scrotal pain lasting at least three months and significantly interfering with daily activities. Despite accounting for 2.5-4.8% of urologic clinic visits, no current established guidelines exist for its diagnosis and management. This study aims to identify the aetiologies of chronic scrotal pain and determine the decrease in patient’s pain symptoms using changes in Visual Analog Scale (VAS) scores following various treatment options.

Objective:
The primary objective is to identify the different possible aetiologies of chronic scrotal pain and evaluate the changes in VAS scores following different treatment modalities.

Study Design:
Prospective Observational Study  

Materials and Methods 
This study included 181 patients aged 18-80 years presenting with chronic scrotal pain to the urology outpatient department. An institutional chronic orchialgia investigation protocol was followed, including urine analysis, ultrasound of the scrotum in all patients and USG scrotum with Doppler, serum PSA and USG abdomen and KUB in selected patients. Patients were initially treated with NSAIDs for two weeks along with physical scrotal supporter. If symptoms were not resolved, tricyclic antidepressant therapy was started for 90 days and changes in VAS score were noted.

Most patients (48.6%) were aged 21-30 years, with a mean age of 31.73±11.84 years. The mean duration of symptoms was 24.26±38.17 months, with a median of 8 months. Varicocele (35.4%) and idiopathic causes (24.3%) were the predominant aetiologies. There was a significant reduction in VAS score from 3.64±1.66 at presentation to 1.17±1.09 after three months (p<0.001). Medical management using a protocol of NSAIDs followed by tricyclic antidepressants was the primary treatment modality (87.3%), with surgical interventions employed in 5.5% of cases.

Significant results were observed through this study for chronic scrotal pain syndrome, stating that, Initial medical management with analgesics followed by tricyclic antidepressants can be used with positive effects in most cases leading to the alleviation of pain symptoms and a distress-free better quality of life.

This study highlights the diverse aetiologies of chronic scrotal pain syndrome and the effectiveness of medical management in reducing pain, as evidenced by significant reductions in VAS scores.