INTRODUCTION AND OBJECTIVE: Prior publications have demonstrated the efficacy of ultrasound guided peri-spermatic cord cryoablation (PSC) as a salvage treatment for patients who failed microsurgical denervation of the spermatic cord (MDSC) for the treatment of chronic scrotal content pain (CSP). This previously published technique was performed in the hospital or ambulatory surgery center setting. Office based techniques offer the advantage of significantly reducing medical charges to the patient, since there are no facility fees. This study was designed to assesses an office based technique (OPSC) for PSC that may offer similar clinical outcomes at a significantly reduced cost to the patient. METHODS: A retrospective review of 35 OPSC cases (26 patients, 9 bilateral cases) between November 2020 to February 2021, performed by one fellowship trained microsurgeon. OPSC was performed under IV sedation in the office using a micro cryoablation needle (Cooper Surgical, Inc., Trumbull, CT). Branches of the genitofemoral, ilioinguinal and inferior hypogastric nerves were cryoablated medial and lateral to the spermatic cord at the level of the external inguinal ring. The level of pain was measured preoperatively and postoperatively using the Visual Analog Scale (VAS) and a validated Chronic Orchialgia Symptom Index (COSI). Median total surgical charges for the OPSC were analyzed for the office, ambulatory surgical center and hospital settings for comparison. RESULTS: Median patient age was 50. Median post-operative follow up was 1 month (1-3). 87% of the patients had a significant reduction in pain (19% complete resolution and 68% had a greater than 50% reduction in pain). No complications were reported. Table 1 below illustrated the median total surgical charges (including anesthesia charges) for the various clinical settings in our county region for PSC. The total surgical and anesthesia insurance charges for OPSC was significantly lower than in the ambulatory and hospital based settings (utilizing IV sedation in all these settings). CONCLUSIONS: Office based ultrasound guided peri-spermatic cord cryoablation (OPSC) is a safe, cost effective treatment option for the salvage management of persistent CSP in patients who have failed MDSC. Source of Funding: None