From the Guidelines
Treatment for testicular pain and swelling should prioritize urgent surgical exploration for suspected testicular torsion, and antibiotic therapy for epididymitis, with a focus on reducing morbidity, mortality, and improving quality of life. The approach to managing testicular pain and swelling depends on the underlying cause, which can be diagnosed using a combination of clinical assessment, laboratory tests, and imaging modalities such as ultrasound 1. For cases of suspected testicular torsion, immediate surgical intervention within 6 hours is crucial to prevent tissue death and preserve testicular function 1. In contrast, epididymitis, which is the most common cause of acute scrotal pain in adolescent boys and adults, can be treated with antibiotics such as ceftriaxone 1000 mg i.m. or i.v. plus a course of an antibiotic active against Chlamydia trachomatis, as recommended by the European Association of Urology guidelines 1.
Some key considerations in the management of testicular pain and swelling include:
- Rest, scrotal support, and over-the-counter pain relievers like ibuprofen or acetaminophen for mild cases
- Antibiotic therapy for bacterial infections such as epididymitis, with consideration of parenteral therapy for severe infections
- Supportive measures such as elevating the scrotum and wearing supportive underwear to reduce swelling and discomfort
- Urgent medical attention for severe or sudden onset of pain, fever, nausea, or vomiting, which may indicate serious conditions requiring prompt treatment
The use of ultrasound as a first-line imaging modality can help differentiate between testicular torsion and epididymitis, with findings such as an enlarged heterogeneous testis, ipsilateral hydrocele, and reduced color Doppler flow in the testis or spermatic cord suggestive of torsion 1. However, clinical correlation and integration with laboratory markers and clinical data are essential to distinguish between these entities and guide appropriate management 1. Overall, a prompt and accurate diagnosis, followed by timely and effective treatment, is critical to reducing morbidity, mortality, and improving quality of life in patients with testicular pain and swelling.
From the Research
Treatment for Testicular Pain and Swelling
The treatment for testicular pain and swelling depends on the underlying cause of the condition.
- For epididymo-orchitis, treatment typically involves antibiotics and pain management 2.
- In cases of testicular torsion, prompt surgical intervention is necessary to prevent permanent damage and preserve testicular function 3, 4, 5.
- Patients who are in severe pain or systemically unwell should be referred for analgesia, IV antibiotics, and hydration 2.
- It is also important to examine the patient for other potential causes of testicular pain and swelling, such as urinary tract infections, bladder outflow obstruction, and prostate issues 2.
Diagnostic Approach
- A thorough history and physical examination are essential in diagnosing the cause of testicular pain and swelling 2, 3, 4, 5.
- Imaging studies, such as Doppler ultrasound, may be used to confirm the diagnosis and rule out other potential causes 3, 4, 5.
- In cases where testicular torsion is suspected, immediate surgical exploration is indicated and should not be postponed to perform imaging studies 3.
Rare Differential Diagnoses
- There are several rare differential diagnoses of acute scrotal pain, including tumors, segmental testicular infarction, testicular vasculitis, pancreatitis, brucellosis, spermatic vein thrombosis, acute aortic syndrome, and appendicitis 6.
- These conditions may be susceptible to misinterpretation as testicular torsion or acute epididymo-orchitis, and surgical management may be indicated in some cases 6.