Editing CUA: Chronic Scrotal Pain (2018) (section)

==== Optional ====

===== Labs =====
* '''Urinalysis +/- culture''' '''(select patients)'''
** '''Should be ordered in the setting of lower urinary tract symptoms, hematuria''', '''or any suspicion of infection''' '''since''' '''CSP may occur in the setting of a symptomatic UTI, STI, or prostatitis'''
* '''Sexually transmitted infection screen (select patients)'''
** If the patient is at a high risk for sexually transmitted infections or has complaints of urethral discharge, urethral symptoms, or penile pain, then a urethral swab or urine for nucleic acid amplification for Neisseria gonorrhea and Chlamydia trachomatis (G+C) should be ordered.
* '''Semen analysis (select patients)'''
** '''May be considered in young patients with CSP and non-proven fertility, especially if an infectious etiology is suspected, such as a history of STI or epididymo-orchitis.'''

===== Imaging =====
* '''Scrotal ultrasound (select patients)'''
** '''Should be performed if there is a palpable abnormality (such as a mass) in the scrotum or where pain or patient body habitus precludes a proper physical examination'''
** Although scrotal US is a safe and relatively inexpensive investigation often ordered in the CSP population, its clinical utility is limited in the setting of a normal scrotal examination and it may detect clinically insignificant findings, potentially leading to further investigations or unnecessary procedures.

===== Other =====
* '''Questionnaire'''
** '''Chronic Epididymitis Symptom Index (CESI)''' 
***Measures the severity, frequency, and impact of chronic epididymitis; can serve as a useful tool for baseline evaluation, as well as follow-up
* '''Spermatic cord block'''
** '''Can serve be both diagnostic and therapeutic''' in patients with idiopathic CSP
** '''Response will help differentiate local scrotal pain from referred pain'''
* '''Psychological evaluation (select patients)'''
** '''Referral to a mental health specialist is indicated if:'''
**# Patient endorses significant psychiatric response to ongoing pain
**# Pain affects non-medical aspects of life (relationships, employment, legal issues)
**# Pain is accompanied by anxiety, depression, or significant mental distress