Background: Intrascrotal nerve tumors, though rare, are significant due to their potential impact on patient health and the complexities in management, especially in distinguishing benign from malignant tumors.Objective: The study aimed to evaluate the diagnosis and management of intrascrotal nerve tumors, focusing on clinical presentation, tumor characteristics, and treatment outcomes.Methods: This prospective study was conducted at the Urology Department, Institute of Kidney Diseases, HMC, Peshawar, from January to June 2023. Fifty-five male patients with confirmed intrascrotal nerve tumors were included. Data were collected from medical records, including demographic information, clinical symptoms, imaging findings, biopsy results, and treatment details. Tumor characteristics were assessed through ultrasonography and MRI. Statistical analysis was performed using SPSS version 25, with significance set at p < 0.05.Results: The mean age was 45.23±2.78 years. Benign tumors accounted for 65% of cases with a mean size of 2.8 cm, while malignant tumors (MPNSTs) accounted for 35% with a mean size of 4.5 cm. Complete excision was achieved in 95% of cases; recurrence was 32% in malignant tumors (p = 0.001). The overall survival rate for malignant tumors was 58% (p = 0.002).Conclusion: Intrascrotal nerve tumors present diagnostic and management challenges, particularly MPNSTs, which require aggressive treatment and close follow-up due to high recurrence rates.