scrotal pain/mass (testicular pain, testicular torsion)
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Etiology
- trauma
- testicular laceration
- hematoma
- hematohydrocele
- testicular torsion
- torsion of testicular & epididymal appendages
- epididymitis
- viral orchitis (mumps)
- hydrocele, hematocele, varicocele, epididymal cyst, spermatocele
- testicular cancer
- renal colic urolithiasis
- inguinal hernia
- acute appendicitis
- distal abdominal aortic aneurysm
- Henoch-Schonlein purpura
- Fournier's gangrene
Clinical manifestations
- torsion of the testicle or testicular appendage
- abrupt onset of pain
- nausea/vomiting, abdominal pain
- pain exacerbated by elevating the testicle onto the pubic symphysis (negative Prehn's sign)
- absence of cremasteric reflex 99& sensitive for testicular torsion[2]
- epididymitis, incarcerated hernia & viral orchitis present with gradual onset of scrotal pain
- pain relieved by elevating the testicle onto the pubic symphysis (Prehn's sign +) suggests epididymitis
- hematuria suggests nephrolithiasis
- hydrocele, testicular cancer, varicocele & epididymal cyst are generally painless
- parotitis preceding testicular pain by 1-2 weeks suggest orchitis
- bowel palpable in scrotum or bowel sounds audible in scrotum suggests inguinal hernia
- painful swelling & erythema of the scrotum or perineum with signs of necrosis & sepsis suggest Fournier's gangrene
Laboratory
Radiology
- flat & upright X-ray of abdomen
- testicular ultrasound or testicular scintigraphy to demonstrate diminished blood flow with testicular torsion
- intravenous pyelogram (IVP)
- renal ultrasound
- abdominal ultrasound
- abdominal CT
Management
- testicular torsion is a surgical emergency
- surgical detorsion must be achieved in 4-6 hours
- after 24 hours, the testicle will be infarcted
- bilateral orchiopexy is indicated to prevent recurrence
- torsion of testicular appendage
- bed rest, analgesia, scrotal elevation
- surgical exploration is indicated when the diagnosis is uncertain or the pain persists
- transillumination
- if mass transiluminates
- it is either a hydrocele or spermatocele
- generally asymptomatic
- may cause discomfort is large
- surgical excision
- aspiration not useful because the recur
- ultrasound not necessary
- if mass does not transilluminate
- ultrasound of mass
- referral to urology
- if mass transiluminates
- see epididymitis
- see urinary calculus
- see varicocele
- epididymal cyst or hydrocele: aspirate if painful
- testicular neoplasm: surgery, radiation, chemotherapy
- see orchitis
- inguinal hernia: surgery
- see appendicitis: surgery
More general terms
More specific terms
Additional terms
References
- ↑ Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 398-401
- ↑ 2.0 2.1 Medical Knowledge Self Assessment Program (MKSAP) 15, 16 American College of Physicians, Philadelphia 2009, 2012
Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022
Wampler SM, Llanes M. Common scrotal and testicular problems. Prim Care. 2010 Sep;37(3):613-26 PMID: https://www.ncbi.nlm.nih.gov/pubmed/20705202