Testicular pain: Difference between revisions
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==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<ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016</ref> <ref>Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X</ref>=== | |||
=== | |||
In | |||
*Epididymal or testicular appendage torsion | *Epididymal or testicular appendage torsion | ||
| Line 58: | Line 21: | ||
*Testicular torsion | *Testicular torsion | ||
*[[Tumor]] | *[[Tumor]] | ||
== 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 === | |||
*''[[Neisseria gonorrhoeae]] and [[Chlamydia trachomatis]]'' culture | |||
*Urinalysis in all patients | |||
=== MRI === | |||
*Recent studies support the use of MRI | |||
=== Ultrasound === | |||
*Use doppler to check for masses | |||
== Treatment == | == Treatment == | ||
| Line 63: | Line 49: | ||
=== Acute Pharmacotherapies === | === Acute Pharmacotherapies === | ||
*[[Epididymitis]] | *[[Epididymitis]] | ||
:* | :*Antibiotic therapy | ||
:*[[NSAID]]s and scrotal elevation | :*[[NSAID]]s and scrotal elevation | ||
*UTI | *[[UTI]] | ||
:* | :*Antibiotic therapy | ||
*[[Tumor]] | *[[Tumor]] | ||
:*Resection | :*[[Resection]] | ||
=== Surgery | === Surgery=== | ||
*[[Testicular torsion]] is an emergency | *[[Testicular torsion]] is an emergency | ||
:*Necessary to salvage testicle | :*Necessary to salvage testicle | ||
:*If surgery is not available, perform manual detorsion | :*If surgery is not available, perform manual detorsion | ||
::*Penetrate [[spermatic cord]] with 10-20mL of 1% [[lidocaine]] | ::*Penetrate [[spermatic cord]] with 10-20mL of 1% [[lidocaine]] | ||
::* | ::*Gently twist testes to the left and right | ||
::*Patient will feel immediate relief upon detorsion | ::*Patient will feel immediate relief upon detorsion | ||
::*Refer to a to a urologist if unsuccessful | ::*Refer to a to a urologist if unsuccessful | ||
*Incarcerated inguinal hernias | *Incarcerated [[inguinal hernias]] and testicular rupture involve surgery | ||
== References == | == References == | ||
{{Reflist|2}} | |||
{{WH}} | |||
{{WS}} | |||
[[Category:Pain]] | |||
[[Category:Urologic Disease]] | [[Category:Urologic Disease]] | ||
[[Category:Symptoms]] | |||
[[Category:Signs and symptoms]] | [[Category:Signs and symptoms]] | ||
[[Category:Needs causes]] | |||
Latest revision as of 00:24, 30 July 2020
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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]
- 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
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
- Neisseria gonorrhoeae and Chlamydia trachomatis culture
- Urinalysis in all patients
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
- 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 and testicular rupture involve surgery