“My testicles hurt!” Scrotal ultrasonography in the evaluation of adult acute scrotal pain.

Testicular torsion is the most common pediatric urologic emergency and is a common cause of acute scrotal pain. Timely diagnosis is important for testicular salvage,as treatment delayed beyond 6 hours from the onset of symptoms is the most predictive factor of testicular death. There is a bimodal distribution of age with extravaginal torsion most commonly presenting in the neonatal period and intravaginal torsion most commonly presenting around the onset of puberty. Intermittent testicular torsion presents a unique challenge in making an accurate diagnosis, as patients most often present when asymptomatic. Several risk factors exist, although bell-clapper deformity is the most important. The diagnosis is made largely on history or physical examination. In equivocal cases, imaging with color Doppler ultrasonography may be helpful in making the diagnosis. Additional tools including near-infrared spectroscopy and Testicular Workup for Ischemia and Suspected Torsion score may be helpful in diagnosing testicular torsion. Possible long-term effects on fertility and hormonal function are also often a concern for the patient and clinician. This review contains 6 figures, 5 tables, and 34 references. Keywords: acute, infarction, ischemia, orchidopexy, scrotum, spermatic cord, testis, torsion

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Intermittent Testicular Torsion

PEDIATRICS ◽

10.1542/peds.77.6.908 ◽

1986 ◽

Vol 77 (6) ◽

pp. 908-911

Author(s):

Thomas J. Stillwell ◽

Stephen A. Kramer

Keyword(s):

Primary Care Physicians ◽

Testicular Torsion ◽

Separate Entity ◽

Scrotal Pain ◽

Young Males ◽

Testicular Pain ◽

Acute Scrotal Pain ◽

History Of ◽

Scrotal Swelling ◽

Physical Findings

Testicular torsion is the most common cause of acute scrotal pain in prepubertal and adolescent boys and should be foremost in the minds of primary care physicians evaluating these children. Intermittent testicular torsion is a separate entity that should be considered in all young males with a history of scrotal pain and swelling. Acute and intermittent sharp testicular pain and scrotal swelling, interspersed with long intervals without symptoms, are characteristic. Physical findings may include horizontal or very mobile testes, an anteriorly located epididymis, or bulkiness of the spermatic cord from partial twisting. Awareness of this entity and early elective orchiopexy will improve testicular salvage in patients with intermittent testicular torsion.

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Approach to Male Urologic Emergencies

10.2310/em.4367 ◽

2019 ◽

Author(s):

Jonathan E. Davis ◽

Jeffrey S. Dubin

Keyword(s):

Emergency Department ◽

Inguinal Hernia ◽

Necrotizing Fasciitis ◽

Testicular Torsion ◽

Diagnosis And Treatment ◽

Acute Scrotum ◽

Scrotal Pain ◽

Penile Pain ◽

Emergency Department Setting ◽

Acute Scrotal Pain

This review details the evaluation and management of the acute scrotum in the emergency department setting and emergent penile complaints in adults, with an emphasis on the most serious and most common conditions. Other emergent conditions include necrotizing fasciitis of the perineum (Fournier disease), incarcerated or strangulated inguinal hernia, and genitourinary (GU) trauma. Emergency practitioners need to be most concerned with the entities that, if left untreated, can result in ischemia and necrosis of the penis. Basic anatomy and bedside evaluation are reviewed. Acute scrotal and penile pain and GU trauma are discussed in terms of assessment and stabilization, diagnosis, and treatment and disposition. This review contains 5 figures, 19 tables, and 71 references. Keywords: Acute scrotal pain, testicular torsion, priapism, Peyronie disease, paraphimosis, phimosis, balanitis, posthitis, epididymitis

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5 Acute Scrotal Pain: Diagnosing with Color Duplex Sonography

Ultrasonography in Urology ◽

10.1055/b-0034-71200 ◽

2008 ◽

Keyword(s):

Duplex Sonography ◽

Color Duplex Sonography ◽

Scrotal Pain ◽

Acute Scrotal Pain

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Case – Tension hydrocele: A rare cause of acute scrotal pain

Canadian Urological Association Journal ◽

10.5489/cuaj.6363 ◽

2020 ◽

Vol 14 (7) ◽

Author(s):

Christopher Bitcon ◽

Joshua White ◽

Ashley Cox ◽

Tom Skinner

Keyword(s):

Scrotal Pain ◽

Acute Scrotal Pain

NA

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Acute Scrotal Pain: Management

Scrotal Pathology - Medical Radiology ◽

10.1007/174_2011_177 ◽

2011 ◽

pp. 91-97

Author(s):

Giuseppe Ocello ◽

Andrea Lissiani ◽

Carlo Trombetta

Keyword(s):

Pain Management ◽

Scrotal Pain ◽

Acute Scrotal Pain

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Imaging Acute Scrotal Pain in Children

Scrotal Pathology - Medical Radiology ◽

10.1007/174_2011_180 ◽

2011 ◽

pp. 125-137

Author(s):

Brian D. Coley ◽

Venkata R. Jayanthi

Keyword(s):

Scrotal Pain ◽

Acute Scrotal Pain

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Acute epididymo-orchitis frombrucellosis melitensisin Australia

BMJ Case Reports ◽

10.1136/bcr-2019-230007 ◽

2019 ◽

Vol 12 (7) ◽

pp. e230007

Author(s):

Christopher Chi Kit Ip ◽

Khrisna Tumali ◽

Ivan M Hoh ◽

Arun Arunasalam

Keyword(s):

Blood Culture ◽

Dairy Products ◽

Endemic Area ◽

Brucella Melitensis ◽

Recent History ◽

Scrotal Pain ◽

Travel History ◽

Persistent Fever ◽

Acute Scrotal Pain ◽

History Of

Brucellosis epididymo-orchitis (BEO) is extremely rare in non-endemic areas such as Australia. While epididymo-orchitis is relatively common in adolescent men, when presented with a significant travel history, consideration should be given to rare causes such as this. Here, we present a case of BEO in a young 18-year-old man who recently migrated from Greece, with symptoms of acute scrotal pain, swelling and persistent fever.Brucella melitensiswas isolated in the blood culture and confirmed with PCR. We suspect transmission was related to ingestion of unpasteurised goat dairy products. He made a full recovery after 7 days of intravenous gentamicin and 6 weeks of oral doxycycline. BEO should be considered in those who present with acute scrotal pain and fever after a recent history of travel to or from a brucellosis- endemic area.

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