Testicular pain
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Testicular pain should always be considered urgent because of possible Fourniers Gangerene or testicular torsion. Cancer is a common fear in patients.
Diagnosis
History and Symptoms
- History and physical exam includes abdomen, back, genitalia and digital rectal exam
- Note:onset, duration, location, quality and any other instances of pain
- Tranilluminate for fluid
- "Blue dot sign"->Blue coloration along upper area seen in 20% of torsion of the testicular appendix and/or due to infarction or necrosis
- Palpate testicle and spermatic cord for:
- effusion
- tenderness
- subcutaneous emphysema
- size
Laboratory Findings
- Neisseria gonorrhoeae & Chlamydia trachomatis culture
- Urinalysis in all patients
Ultrasound
- Use doppler to check for masses
MRI and CT
- Recent studies support the use of MRI
Differential Diagnosis
In alphabetical order. [1] [1]
- Epididymal or testicular appendage torsion
- Epididymysis
- Fournier's Gangrene
- Henoch-Schönlein purpura
- Hydrocele
- Peritonitis
- Referred pain due to an incarcerated hernia, constipation or kidney stone
- Ruptured abdominal aneurysm
- Scrotal trauma
- Testicular torsion
- Tumor
Treatment
Acute Pharmacotherapies
- antibiotic therapy
- NSAIDs and scrotal elevation
- UTI
- antibiotic therapy
- Resection
Surgery and Device Based Therapy
- Testicular torsion is an emergency
- Necessary to salvage testicle
- If surgery is not available, perform manual detorsion
- Penetrate spermatic cord with 10-20mL of 1% lidocaine
- gently twist testes to the left and right
- Patient will feel immediate relief upon detorsion
- Refer to a to a urologist if unsuccessful
- Incarcerated inguinal hernias & testicular rupture involve surgery
References
Acknowledgement and Attribution Regarding Sources of Content
Some of the initial content on this page may be incorporated in part from copyleft sources in the public domain including wikis such as Wikipedia and AskDrWiki. Drug information for patients came from the The National Library of Medicine. Infectious disease information may have come from the Centers for Disease Control (CDC). Differential Diagnoses are drawn from clinicians as well as an amalgamation of 3 sources: 1.The Disease Database; 2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:3; 3. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:7 .

