Can the Rate of Idiopathic Cases in Chronic Scrotal Pain be Reduced with an Effective Multidisciplinary Approach?

According to the literature, approximately 1% of urology clinic visits-particularly those by young men-are related to CSP.In addition, complaints of scrotal pain account for 2-5% of outpatient urology visits (2,3).The etiology of CSP is multifactorial.Infectious conditions, previous surgical interventions, vascular pathologies, neurogenic and musculoskeletal causes, as well as retroperitoneal and scrotal malignancies, have all been reported as potential etiological AbstractObjective: This study aims to evaluate the etiological distribution among patients presenting with chronic scrotal pain, to demonstrate the contribution of a multidisciplinary approach to diagnosis, and to help determine possible causes, especially in cases classified as idiopathic. Materials and Methods:In this retrospective study, 127 patients (mean age 35 years, range 18-66 years) who presented to our urology clinic with chronic scrotal pain (CSP) between January 2023 and June 2025 were evaluated.All patients underwent a diagnostic evaluation, including a detailed medical history, a comprehensive physical examination, scrotal Doppler ultrasonography, and laboratory investigations.To identify possible sources of pain beyond urological causes, patients were evaluated in multidisciplinary consultations.Results: Pain was unilateral in 40 patients (31.5%) and bilateral in 87 patients (68.5%).Chronic epididymitis and prostatitis were present in 25 patients (19.68%); varicocele was present in 27 patients (21.26%); and pain after varicocelectomy-inguinal hernia repair was present in 18 patients (14.17%).Of the 57 patients (44.90%) with undetermined urological etiology, 20 (15.75%) were diagnosed with perianal pathologies during consultation in the general surgery clinic, and 7 (5.51%) were diagnosed with lumbar disc herniation during consultation in the neurosurgery clinic.The cause of pain could not be determined in 30 patients (23.62%). Conclusion:CSP is a multifactorial clinical condition.We believe that rates of idiopathic cases, reported in the literature as 35-45%, can be reduced to 23.62%, as observed in our study, through a multidisciplinary approach that includes systematic evaluation and clinical consultations.