Testicular pain

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Testicular pain should always be considered urgent because of possible Fourniers Gangerene or testicular torsion. Cancer is a common fear in patients.

Differentiating Testicular Pain from other Diseases

In Alphabetical Order[1] [2]

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
  • Transilluminate 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

MRI

  • Recent studies support the use of MRI

Ultrasound

  • Use doppler to check for masses

Treatment

Acute Pharmacotherapies

  • Antibiotic therapy
  • NSAIDs and scrotal elevation
  • Antibiotic therapy

Surgery

  • 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

References

  1. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016
  2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X



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