Testicular pain: Difference between revisions
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== Differential Diagnosis == | == Differential Diagnosis == | ||
In | 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> | ||
*Epididymal or testicular appendage torsion | *Epididymal or testicular appendage torsion |
Revision as of 18:59, 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 and 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