Background <p>Scrotal leakage of dialysate, a serious complication in Continuous Ambulatory Peritoneal Dialysis (CAPD) patients, results from elevated intra-abdominal pressure. It increases infection risk, impairs ultrafiltration, and reduces quality of life. Conventional diagnostic methods often lack sensitivity and dynamic assessment, leading to delayed management.</p> Objective <p>To evaluate the efficacy of iopromide CT peritoneography (CTp) in diagnosing scrotal dialysate leakage and its role in guiding clinical decisions, and to summarize the management pathway.</p> Methods <p>Eight CAPD patients with suspected scrotal leakage between August 2020 and August 2025 underwent CTp. Clinical baseline characteristics, dialysis duration, symptom onset, and diagnostic-therapeutic timelines were analyzed.</p> Results <p>CT peritoneography accurately identified the sites and tracts of dialysate leakage, facilitating prompt clinical intervention. A multidisciplinary management strategy, incorporating individualized dialysis prescription adjustments and subsequent laparoscopic repair, was associated with successful leak resolution and favorable patient outcomes in this case series. Commonly observed clinical features in our case series included overweight, hypertension, and hypoalbuminemia.</p> Clinical trial number <p>(Project No.: 2025-100)</p>