Office-based salvage radical orchiectomy for the treatment of chronic orchialgia: Technique and outcomes

• Office-based salvage radical orchiectomy offers durable pain relief. • Procedure performed under IV sedation with minimal complications. • Significant pain reduction observed by 1-month post-op, with long-term benefits. • 78 % of patients reported improved quality of life by 6 months post-op. • Pain relief was sustained in most patients at 2-year follow-up post-orchiectomy. Chronic scrotal content pain (CSCP) is a debilitating condition affecting over 100,000 men annually, often resulting in significant healthcare utilization and impaired quality of life. While treatment options range from conservative management to surgical interventions, a subset of patients with refractory pain may require salvage radical orchiectomy. This study evaluates the feasibility, safety, and efficacy of office-based salvage radical orchiectomy performed under intravenous sedation as a cost-effective alternative to traditional inpatient approaches. Fourteen patients with refractory chronic orchialgia underwent office-based salvage radical orchiectomy between September 2021 and October 2024. Procedures were performed under regional nerve block and intravenous sedation, utilizing a meticulous surgical technique emphasizing double-segment spermatic cord ligation to minimize stump pain. Patients were followed for up to two years, with Chronic Orchialgia Symptom Index (COSI) scores recorded preoperatively and at multiple postoperative timepoints. The mean operative duration was 38 min. Significant pain reduction was observed, with mean COSI scores decreasing from 25 preoperatively to 4.8 at two years postoperatively. By six months, 78 % of patients reported substantial improvement. Complications were minimal, including one case each of scrotal swelling and hematoma, both managed conservatively. This study highlights office-based orchiectomy as a safe, effective, and cost-efficient alternative, offering substantial pain relief and minimal complications. While these findings align with existing inpatient data, larger multicenter studies are warranted to validate long-term outcomes and broader applicability. This approach represents a significant advancement in the management of refractory CSCP.