Treatments — Scrotal & Andrology
Scrotal Pain — Specialist Assessment & Surgical Treatment
Chronic scrotal pain is a complex, often poorly managed condition that significantly affects quality of life. Mr. Jesuraj offers specialist assessment and the full range of surgical treatments — including microsurgical procedures available at very few UK centres.
Thorough assessment to identify the specific cause before any treatment is recommended.
Zeiss operating microscope — enabling microsurgical denervation and reconstruction unavailable at most centres.
Scrotal pain can be debilitating and isolating. We take every presentation seriously and with complete discretion.
Understanding the Problem
Why Scrotal Pain Is Often Poorly Managed
Chronic scrotal pain — defined as intermittent or constant pain in the scrotum lasting more than 3 months — is surprisingly common but frequently under-investigated. Many men are given a diagnosis of “orchalgia” without any attempt to identify the underlying cause, and are offered little more than analgesia and reassurance.
The reality is that scrotal pain has many distinct causes — each requiring a different approach. Without proper assessment, treatment is essentially guesswork. Mr. Jesuraj takes a systematic approach: thorough history, clinical examination, targeted imaging, and a structured surgical decision-making pathway where conservative measures have failed.
Importantly, testicular cancer must always be excluded in any man presenting with scrotal pain or a new scrotal finding. This is done rapidly with ultrasound and appropriate blood tests.
Common Causes of Scrotal Pain
- Post-vasectomy pain syndrome — congestive or neuropathic
- Epididymo-orchitis — acute or chronic inflammation
- Epididymal cysts — causing pressure or congestion
- Varicocele — aching, dragging discomfort
- Sperm granuloma — at vasectomy site
- Retractile testis — intermittent pain from abnormal position
- Hydrocele — pressure from fluid collection
- Referred pain — from hernia, kidney stones, spine
- Idiopathic orchalgia — no identifiable cause after full assessment
Assessment
How We Assess Scrotal Pain
A structured assessment is essential before any treatment — surgical or otherwise — is considered.
Detailed History
Duration, character (aching, sharp, burning), laterality, onset, relationship to activity or ejaculation, previous vasectomy or scrotal surgery, urinary symptoms, sexual history.
Clinical Examination
Assessment of testicular position, epididymis, vas deferens, cord structures, inguinal hernia, skin changes. Palpation of the vasectomy site for sperm granuloma.
Scrotal Ultrasound
Doppler ultrasound to assess testicular blood flow, identify epididymal changes, varicocele, hydrocele, cysts, and exclude testicular tumour. Essential in all cases.
Urine & Blood Tests
MSU for infection, STI screen where appropriate, tumour markers (AFP, βHCG, LDH) if testicular tumour is a concern.
Spermatic Cord Block
A diagnostic and therapeutic injection of local anaesthetic around the spermatic cord. If pain resolves temporarily, this confirms the pain pathway and predicts response to surgical denervation.
Conservative Treatment First
Where appropriate: analgesia, anti-inflammatory medication, scrotal support, antibiotic treatment of epididymo-orchitis, physiotherapy referral. Surgery is only considered when conservative measures have genuinely failed.
Surgical Treatments
Surgical Options for Scrotal Pain
Surgery is considered when a specific, correctable cause has been identified and conservative treatment has failed. Mr. Jesuraj offers the full range of surgical options — including microsurgical procedures not available at most UK centres.
Microsurgical Denervation of the Spermatic Cord
For chronic orchalgia and post-vasectomy pain — when all other treatments have failed
Microsurgical denervation of the spermatic cord (MDSC) is the most effective surgical treatment for chronic scrotal pain when a specific anatomical cause cannot be corrected. Under the Zeiss operating microscope at 15–25x magnification, the pain-transmitting nerve fibres running within the spermatic cord are selectively divided — while carefully preserving the testicular artery, vas deferens, and lymphatic vessels.
This selectivity is only possible with the operating microscope. Non-microsurgical approaches risk injury to the testicular blood supply, potentially causing testicular atrophy. Mr. Jesuraj is one of a small number of surgeons in the UK with the training and equipment to perform this procedure safely.
Patient selection is critical. A positive response to diagnostic spermatic cord block (pain relief with local anaesthetic injection) predicts a good surgical outcome. Success rates of approximately 75% significant pain improvement are reported in carefully selected patients.
Vasectomy Reversal for Post-Vasectomy Pain
Restoring patency to relieve congestive epididymal pain
Post-vasectomy pain syndrome (PVPS) affects approximately 1–2% of men following vasectomy. In many cases it is caused by back-pressure and congestion in the epididymis — the coiled tube behind the testicle — where sperm accumulate after the vas is blocked. Reversing the vasectomy relieves this congestion and resolves the pain in many cases.
Mr. Jesuraj performs the gold standard microsurgical reversal using the Microdot Multilayer technique — the same procedure used for fertility restoration. Even when fertility is not the goal, this technique offers the best surgical outcome. Pain relief is achieved in approximately 50–70% of men with congestive-type PVPS.
Excision of Sperm Granuloma
Removal of inflammatory nodule at the vasectomy site
A sperm granuloma is a small inflammatory nodule that forms at the vasectomy site — caused by sperm leaking from the cut end of the vas deferens and triggering a local immune reaction. It presents as a tender, palpable lump at the vasectomy site, and can be a significant source of localised pain.
Diagnosis is clinical — a tender nodule at the vasectomy site is characteristic. Ultrasound can confirm the finding. Treatment is surgical excision of the granuloma. The procedure is performed under local anaesthetic through a small incision at the vasectomy site. Histological examination of the excised tissue confirms the diagnosis and excludes other pathology.
This is a straightforward procedure with excellent results when the sperm granuloma is the confirmed source of pain.
Surgery for Retractile Testis (Orchidopexy)
Fixing a testis that moves abnormally between the scrotum and groin
A retractile testis is one that moves readily between the scrotum and the inguinal canal due to an overactive cremasteric reflex. In many cases this is benign and requires only observation. However, in some men — particularly those in whom the testis spends significant time in the inguinal region — it causes intermittent scrotal pain, aching in the groin, and occasionally torsion events.
When retractile testis is causing symptomatic pain and conservative management has failed, orchidopexy (surgical fixation of the testis in the scrotum) is performed. The testis is mobilised, the cremasteric fibres are divided to allow adequate scrotal length, and the testis is secured within a dartos pouch in the scrotum — preventing further retraction.
This is also performed in adults where an ascending testis is identified — a previously scrotal testis that has become retractile or undescended with age.
Epididymectomy
Surgical removal of the epididymis for chronic epididymal pain
Epididymectomy — surgical removal of the epididymis — is occasionally considered in men with chronic epididymal pain (epididymodynia) that is clearly localised to the epididymis and has failed all conservative and less invasive treatments. It is a procedure of last resort and is only appropriate when pain is definitively localised and the patient understands the risks, including the possibility of persistent pain.
The procedure preserves the testis and its blood supply while removing the painful epididymis. It is performed under general anaesthetic and requires careful microsurgical dissection to protect the testicular vasculature. Results are variable and patient selection is critical — this is a decision made carefully with full informed consent.
Surgery Is Not Always the Answer
Mr. Jesuraj is highly experienced in the surgical management of scrotal pain — but he also understands that surgery does not always resolve the problem, and that patient selection is everything. He will always give you an honest assessment of whether surgery is appropriate for your situation, what the realistic chances of improvement are, and what the alternatives are. No patient is ever pushed towards surgery.
Many men with chronic scrotal pain benefit significantly from a combination of conservative measures, psychological support, and a careful explanation of the anatomy — without ever needing an operation.
Your Journey
From Assessment to Resolution
Consultation
Full history, examination and targeted investigations. Ultrasound arranged. All possible causes systematically assessed.
Conservative Treatment
Appropriate medical management — analgesia, antibiotics, physiotherapy referral, scrotal support — before surgery is considered.
Cord Block Test
Diagnostic spermatic cord block where surgical denervation is being considered — to predict surgical response.
Surgical Treatment
The appropriate procedure — denervation, reversal, granuloma excision, orchidopexy — performed to the highest standard.
You Don’t Have to Live With This Pain
Appointments at Best Life Clinic, Stockton-on-Tees — Monday, Thursday and Friday. Most patients seen within 7 days. No GP referral required.