Testicular pain

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

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.


 * 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

Acute Pharmacotherapies

 * Epididymitis
 * antibiotic therapy
 * NSAIDs and scrotal elevation


 * UTI
 * antibiotic therapy


 * Tumor
 * 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