Introduction: Chronic scrotal content pain (CSP) or chronic orchialgia can be debilitating for patients and difficult to treat. There is a paucity of structured treatment algorithms to approach this difficult condition. Methods: A review of the literature was performed. Conservative treatment options are presented and then targeted surgical interventions that the urologist may perform are then presented in a structured algorithm format. Many of these patients may obtain a significant reduction in pain with some of these treatments. Results: This review presents the pathophysiology, a new assessment tool, and various treatment options available for CSP patients, such as targeted spermatic cord blocks, targeted and standard microsurgical denervation of the spermatic cord (77-100% success rates), ultrasound-guided peri-spermatic cord and ilioinguinal cryoablation (59-75% success rates), scrotox (botox) (56-72% success rates), targeted ilioinguinal and iliohypogastric peripheral nerve stimulation (72% success rate), radical orchiectomy (20-75% success rate), targeted robotic-assisted intra-abdominal denervation (71% success rate) and vasectomy reversal (69-100% success rates). Conclusion: A structured and evidence-based approach to help urologists manage patients with chronic orchialgia or scrotal content pain is presented.

Some researchers have speculated that the prostatic microbiome is involved in the development of prostate cancer (PCa) but there is no consensus on certain microbiota in the prostatic tissue of PCa vs. healthy controls. This systematic review aims to investigate and compare the microbiome of PCa and healthy tissue to determine the microbial association with the pathogenesis of PCa. We searched MEDLINE, Embase, and Scopus databases. Articles were screened by two independent and blinded reviewers. Literature that compared the prostatic tissue microbiome of patients with PCa with benign controls was included. We found that PCa may be associated with increased Propionibacterium acnes, the herpesviridae and papillomaviridae families, and Mycoplasma genitalium, but definitive conclusions cannot be drawn from the existing data. Challenges include the difficulty of obtaining uncontaminated tissue samples and securing tissue from healthy controls. As a result, methods are varied with many studies using cancerous and “healthy” tissue from the same prostate. The organisms chosen for each study were also highly variable, making it difficult to compare studies. These issues have led to lower confidence in our results. Overall, further work is warranted to better understand the implications of the prostatic microbiome in the pathogenesis of PCa.

Robot-assisted microsurgery is a trending approach for the treatment of male infertility and chronic scrotal pain. The advantages seem to include increased optical magnification, improved surgical efficiency, absent tremor, and similar outcomes with standard methods. This chapter covers robotic microsurgical application and techniques for: robot-assisted vasectomy reversal with vasovasostomy and vasoepididymostomy, varicocelectomy, microsurgical testicular sperm extraction, and targeted denervation of the spermatic cord.

Objective: To assess the efficacy and safety of low‐intensity shockwave therapy (LiSWT) for treating erectile dysfunction (ED) compared to sham therapy. Methods: This summary is based on the Cochrane systematic review published in the Cochrane Database of Systematic Reviews 2025, Issue 7 (CD013166). We included randomised controlled trials (RCTs) comparing LiSWT to sham therapy. We excluded psychogenic or iatrogenic ED, kidney transplants, or radical prostatectomy. Critical outcomes were erectile function, discontinuation, and adverse events; important outcomes included rigidity, satisfaction, and quality of life. Certainty was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. Results: A total of 21 RCTs (1357 men, aged 39–65 years) were analysed. LiSWT may slightly improve short‐term erectile function (mean difference [MD] 3.89, 95% confidence interval [CI] 2.89–4.89; I ² = 62%; 15 studies; low‐certainty), though clinical importance is uncertain. Long‐term function may improve (MD 5.25, 95% CI 2.47–8.04; I ² = 87%; five studies; low‐certainty). LiSWT likely has little effect on discontinuation (risk ratio 0.77, 95% CI 0.47–1.27; I ² = 0%) or adverse events (risk difference 0.00, 95% CI −0.01 to 0.02; I ² = 0%). It may improve short‐term penile rigidity (MD 1.06, 95% CI 0.83–1.28; I ² = 53%; low‐certainty). Data for satisfaction or quality of life were unavailable. Conclusions: Low‐intensity shockwave therapy may improve long‐term erectile function and short‐term rigidity, with little difference in discontinuation or adverse events. Evidence certainty is low due to methodological limitations and heterogeneity.