Background <p>Microsurgical denervation of the spermatic cord (MDSC) is one of the lines of management of chronic orchialgia, but it has not been fully adopted by different centers. This article reviews a case series experience with a review of literature.</p> Methods <p>This study is a prospective pilot study evaluating the safety and efficacy of MDSC in the management of chronic scrotal pain refractory to conservative management. The study included 30 patients who underwent unilateral MDSC. Efficacy of the technique was evaluated by the degree of pain improvement using the Visual Analogue Scale (VAS) which was done preoperatively and 6 months postoperatively. Safety was assessed by reporting any perioperative complications. Available literature was reviewed looking at safety and efficacy of the technique.</p> Results <p>Twenty patients had complete pain resolution, 5 had a partial but significant resolution of their pain and the pain remained the same in two patients following MDSC. The VAS pain score significantly improved from a median (IQR) of 8.4 (7.0–9.0) to 1.1 (0–9.0) postoperatively (<i>p</i> = 0.0029). No significant complications have been encountered in this study.</p> Conclusions <p>MDSC seems to be a safe and efficacious surgical option for the treatment of refractory chronic scrotal pain (CSP) and should be more widely adopted by specialist centers.</p>