From the Guidelines
Testicular pain should be evaluated promptly with a physical examination and diagnostic tests, including ultrasound, to determine the cause and prevent potential complications, with color Doppler ultrasound being particularly useful in diagnosing testicular torsion. When evaluating testicular pain, a thorough physical examination is essential, including inspection and palpation of the testicles, checking for swelling, tenderness, and masses 1. The diagnostic approach may involve urinalysis to check for infection, ultrasound to visualize the testicles and blood flow, and sometimes blood tests to check for infection markers or hormonal abnormalities. In cases of suspected testicular torsion, color Doppler ultrasound is the preferred diagnostic test due to its ability to evaluate testicular perfusion and detect reduced blood flow, which is critical for prompt intervention 1. The sensitivity and specificity of color Doppler US for the detection of testicular torsion can vary, but it remains a valuable tool in combination with clinical history and physical examination 1. Other causes of testicular pain, such as epididymitis, orchitis, trauma, hernias, or kidney stones, require different treatment approaches and can be differentiated with the help of ultrasound findings, including an enlarged and hypoechoic epididymis in epididymitis, and clinical correlation 1. Prompt evaluation and treatment are crucial, especially in cases of testicular torsion, where timely intervention can prevent permanent damage and improve outcomes 1.
From the Research
Testicular Pain Testing
- Testicular torsion is a surgical emergency that requires prompt recognition and treatment to prevent complications such as testicular infarction, necrosis, and sub/infertility 2, 3.
- The diagnosis of testicular torsion is typically made based on a combination of history, physical examination, and imaging studies such as Doppler ultrasound scan 4.
- Patients with testicular torsion typically present with severe acute unilateral scrotal pain, nausea, and vomiting, and may have a high-riding testicle with an absent cremasteric reflex 2.
- Epididymo-orchitis is another common cause of testicular pain, and is typically characterized by a gradual onset of scrotal pain and symptoms of lower urinary tract infection, including fever 5.
- The differential diagnosis of testicular pain is crucial, and advanced practice nurses should consider testicular torsion in any patient with testicular pain, regardless of age, history, or physical examination findings 4.
Diagnostic Approaches
- A thorough history and physical examination are essential in the diagnosis of testicular torsion and epididymo-orchitis 3, 5.
- Imaging studies such as Doppler ultrasound scan can help confirm the diagnosis of testicular torsion 4.
- Laboratory studies, including urethral Gram stain, urinalysis and culture, and polymerase chain reaction assay for C. trachomatis and N. gonorrhoeae, can help guide therapy for epididymo-orchitis 5.
Management Strategies
- Prompt surgical exploration is indicated in cases of suspected testicular torsion, and should not be postponed to perform imaging studies 2.
- Patients with epididymo-orchitis should be treated with empirical antibiotics that target the most common pathogens, such as ceftriaxone and doxycycline for C. trachomatis and N. gonorrhoeae, or ofloxacin or levofloxacin for coliform bacteria 5.
- Immediate attention to testicular torsion and epididymo-orchitis is crucial to prevent complications and improve outcomes 2, 3, 4.