Testicular pain

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

## Overview

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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

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### In Alphabetical Order[1] [2]

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* 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

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### History and Symptoms

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* 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

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* Neisseria gonorrhoeae and Chlamydia trachomatis culture
* Urinalysis in all patients

### MRI

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* Recent studies support the use of MRI

### Ultrasound

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* Use doppler to check for masses

## Treatment

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### Acute Pharmacotherapies

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* Epididymitis

* Antibiotic therapy
* NSAIDs and scrotal elevation

* UTI

* Antibiotic therapy

* Tumor

* Resection

### Surgery

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* 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

## References

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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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