Information
Editors
Testis Pain
Essentials
- Diagnose and treat testis torsion immediately.
- Treat epididymitis with antimicrobials. In adolescents, remember the possibility of a chlamydia infection.
- Diagnose varicocele as a cause of prolonged testis pain.
- In association with acute abdominal pain, remember to examine the testes.
Testis torsion
- The aetiology of acute testis pain is testis torsion until proven otherwise.
- Typical patients are children and adolescents who are not yet sexually active, but testis torsion can also occur in adults.
- Pain, which is often felt initially in the lower abdomen and only later in the scrotum, and unilateral swelling of the scrotum start suddenly.
- The testicle rises in the upper part of the scrotum and lies there horizontally, but in the initial phase, tenderness of the testicle often is the only finding.
- Torsion of appendix testis and epididymitis may resemble testis torsion. The differential diagnosis can often be made only in an operation.
- Testis torsion should be treated with an urgent operation to untwist the torsion and to fix both testicles in place within the scrotum.
Epididymitis
- Swelling and tenderness are located in the epididymis, but the testis itself may also be tender. The scrotum is often swollen, reddened and hot.
- Symptoms associated with urination are often present: pain, burning and frequency.
- The causative agents include bacteria causing urinary tract infections, and in sexually active patients also chlamydiae and sometimes gonococci. In older men retention problems may be a predisposing factor.
- Epididymitis occurs also before the sexually active age.
- In children epididymitis is apparently caused by the passage of sterile or infected urine to the deferent duct. In recurrences, ultrasonography of the urinary tracts is a worthwhile examination for excluding e.g., ectopic ureter. Attention should also be paid to enuresis and difficulties in voiding.
- In all age groups manipulation of the urethra, such as prolonged indwelling catheterization and urological interventions, predispose to epididymitis.
- Investigations
- CRP
- Chemical urinalysis and urine culture
- Nucleic acid testing for chlamydia and gonorrhoea
- The initial treatment in children consists of trimethoprim-sulphamethoxazole or a cephalosporin derivative, and of a fluoroquinolone in other patients. If needed, the treatment is changed according to sensitivity testing. Duration of treatment is 2 weeks.
- A suspensor to support the scrotum, cool bandages, and NSAIDs relieve pain.
Orchitis
- The swelling is located in the testis itself.
- Orchitis is very uncommon in countries where mumps has disappeared as a result of vaccinations, but may be associated with epididymitis (epididymo-orchitis).
- The differential diagnosis of orchitis and testicular torsion is difficult (refer to hospital urgently if there is the slightest doubt).
- Investigations
- Parotitis serology (paired serum samples) from the unvaccinated
- Treatment