From the Guidelines
The approach to assessing and evaluating scrotal findings should begin with a thorough history and physical examination, followed by appropriate diagnostic testing, with scrotal ultrasound with color Doppler being the gold standard imaging modality due to its high sensitivity in detecting testicular torsion, masses, epididymitis, and other pathologies 1.
Key Components of Assessment
- A thorough history should include inquiries about pain onset, duration, severity, radiation, and associated symptoms such as fever, dysuria, or urethral discharge.
- The physical examination should include inspection and palpation of both testes, epididymides, and the spermatic cord while having the patient stand.
- Transillumination can help differentiate solid masses from hydroceles.
Diagnostic Testing
- Scrotal ultrasound with color Doppler is the first-line imaging modality for acute scrotal disease and can diagnose most scrotal disorders promptly and with high accuracy 1.
- Urinalysis and urine culture should be obtained when infection is suspected.
- Tumor markers (beta-hCG, AFP, LDH) are essential when testicular cancer is a concern.
Importance of Prompt Evaluation
- In cases of acute scrotal pain, prompt evaluation is critical as testicular torsion represents a surgical emergency requiring intervention within 6 hours to preserve testicular function 1.
Differential Diagnosis
- The differential diagnosis for scrotal findings includes testicular torsion, epididymitis, orchitis, testicular cancer, hydrocele, varicocele, spermatocele, and trauma, each requiring different management approaches based on the clinical presentation and diagnostic findings 1.
From the Research
Approach to Assessing and Evaluating Scrotal Findings
The approach to assessing and evaluating scrotal findings involves a combination of history taking, physical examination, and diagnostic tests. The key is to identify potential emergency conditions, such as testicular torsion, epididymitis, and strangulated hernia, which require immediate attention 2, 3, 4.
History Taking and Physical Examination
A thorough history and physical examination are essential in evaluating scrotal findings. The patient's symptoms, such as pain, swelling, and redness, should be noted, as well as any associated symptoms like nausea and vomiting 2, 3, 5. The physical examination should include an assessment of the testicles, epididymis, and spermatic cord, as well as evaluation of the cremasteric reflex 3, 4.
Diagnostic Tests
Diagnostic tests, such as ultrasonography, may be used to confirm the diagnosis and assess testicular perfusion 3, 6, 4. Doppler ultrasonography can help differentiate between testicular torsion and epididymitis/orchitis 4. Other tests, such as testicular radionuclide scanning, may also be used in certain cases 3.
Differential Diagnosis
The differential diagnosis for scrotal findings includes:
- Testicular torsion: characterized by rapid onset of pain, nausea and vomiting, high position of the testicle, and abnormal cremasteric reflex 3, 4
- Epididymitis/orchitis: characterized by slower onset of pain, increased blood flow on ultrasonography, and elevated C-reactive protein level 3, 4
- Hydrocele: a benign condition characterized by a fluid-filled sac around the testicle 2, 4
- Varicocele: a benign condition characterized by dilated veins in the scrotum 2, 4
- Testicular malignancies: may cause pain in 15% of cases, and ultrasonography may show an intratesticular mass 4
Management
The management of scrotal findings depends on the underlying condition. Emergency conditions, such as testicular torsion and strangulated hernia, require immediate surgical intervention 3, 4. Other conditions, such as hydrocele and varicocele, may be managed in non-urgent settings 2, 4. Referral to a urologist may be necessary for further evaluation and management 2, 3, 4.