From the Guidelines
A positive Prehn's sign indicates epididymitis, which is inflammation of the epididymis, as it is characterized by relief of scrotal pain when the testes are elevated over the symphysis pubis. This clinical sign is crucial in differentiating epididymitis from testicular torsion, as the latter condition does not experience pain relief with elevation 1. The mechanism behind the relief in epididymitis is thought to be the reduction of venous congestion and inflammation, thereby decreasing pain.
Key Points to Consider
- Epididymitis typically presents with a more insidious and gradual onset of pain compared to testicular torsion, which is usually sudden 1.
- A reactive hydrocele may develop in epididymitis, making clinical differentiation from testicular torsion challenging without the use of specific signs like Prehn's sign or advanced imaging techniques 1.
- The treatment of epididymitis often involves antibiotics, such as ciprofloxacin or doxycycline, for 10-14 days, alongside pain management with NSAIDs, scrotal support, and rest.
- While a positive Prehn's sign suggests epididymitis, it should be considered in conjunction with other clinical findings, including the onset of pain, presence of urinary symptoms, and results from diagnostic imaging like color Doppler ultrasound, which can show increased blood flow to the affected testicle, supporting the diagnosis of epididymitis 1.
From the Research
Prehn's Sign
- Prehn's sign is a clinical test used to differentiate between testicular torsion and epididymitis.
- A positive Prehn's sign indicates relief of pain when the testicle is elevated, which is more commonly associated with epididymitis 2, 3.
- In contrast, testicular torsion typically presents with severe pain that is not relieved by elevation of the testicle 4, 3.
- The sensitivity and specificity of Prehn's sign in diagnosing testicular torsion or epididymitis are not well established, and other clinical clues such as pain duration, cremasteric reflex, and laboratory studies should also be considered 3.
- It is essential to note that a positive Prehn's sign does not rule out testicular torsion, and prompt surgical exploration should be performed if torsion is highly suspected 4, 3.