Testicular pain: Difference between revisions
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==Overview== | ==Overview== | ||
Testicular pain should always be considered urgent because of possible Fourniers Gangerene or testicular torsion. Cancer is a common fear in patients. | |||
== Diagnosis == | == Diagnosis == | ||
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=== 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 | ||
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:*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 | ||
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== References == | == References == | ||
{{ | {{Reflist|2}} | ||
[[Category:Primary care]] | [[Category:Primary care]] | ||
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[[Category:Urologic Disease]] | [[Category:Urologic Disease]] | ||
[[Category:Signs and symptoms]] | [[Category:Signs and symptoms]] | ||
[[Category: | [[Category:Needs causes]] | ||
{{WH}} | {{WH}} | ||
{{ | {{WS}} | ||
Revision as of 18:58, 26 March 2013
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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.
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] [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
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