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Medical emergencies that cause scrotal pain include testicular torsion, incarcerated hernia, appendicitis, trauma, and referred pain from ruptured abdominal aortic aneurysms or acute aortic dissection (rare). Other causes include appendiceal torsion, epididymo-orchitis, testicular tumor, hydrocele, varicocele, prostatitis, vasculitis (eg, Henoch-Schönlein purpura, polyarteritis nodosa), and referred pain from ureteral calculi.
Evaluation
History and physical
examination:
The focus is to distinguish emergency from other causes. Aortic catastrophes occur in older patients (> 50 yr); the other emergency conditions can occur at any age. Severe, instantaneous onset pain suggests torsion; pain with incarcerated hernia or appendicitis is more gradual. Tenderness localized to the upper testicular pole suggests appendiceal torsion. Bilateral pain suggests infection or a referred cause. An inguinal mass suggests hernia; scrotal mass is nonspecific. A normal scrotal examination suggests referred pain. Relief of pain with testicular elevation suggests epididymo-orchitis.
Testing:
Urinalysis is always required. Findings of UTI suggest epididymitis. If the etiology of acute testicular pain is equivocal, color Doppler ultrasonography is generally performed to rule out testicular torsion. If Doppler ultrasonography is not available, radionuclide scanning may be useful but is less sensitive and specific.
Treatment
Analgesics are indicated for control of acute pain; morphine or other opioids may be indicated for conditions requiring surgical treatment. Definitive treatment is directed at the cause.
Last full review/revision November 2005
Content last modified November 2005
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