Urology – Scrotal Pain: By Rob Siemens M.D.


There are several serious conditions that
cannot be missed that cause scrotal pain, including testicular torsion – usually presenting
in younger males and Fournier’s gangrene – usually seen in diabetics. When evaluating a patient with scrotal pain
consider the age of the patient, the nature and duration of the pain and the presence
or absence of a mass. Acute, severe testicular pain in a child or
adolescent is testicular torsion until proven otherwise; a scrotal ultrasound should be
obtained to rule it out, and surgical exploration within 4 hours is necessary to avoid testicular
loss. In an elderly diabetic with overlying cellulitis
be suspicious for Fournier’s gangrene. Look for black foul-smelling penile, scrotal,
groin and perineal lesions representing a necrotising fasciitis. Urgent surgical debridement and broad-spectrum
antibiotics are necessary. A mass may be present in a patient with scrotal
pain. A good history and physical examination plus
a scrotal ultrasound will help rule in or out common causes including hydroceles and
epididymal cysts. Also remember that while testicular cancer
is usually painless, in men between 15 and 35 mild pain may be present. Urgent ultrasound and urology referral is
necessary when testicular cancer is suspected. An infectious epididymitis/orchitis is a common
cause of acute or sub-acute scrotal pain. The diagnosis is generally made on history
and physical examination. Management includes rest, scrotal support,
anti-inflammatories and antibiotics. Also remember that scrotal pain may be referred
from elsewhere. So remember to rule out common causes such
as ureteric stones, inguinal pathology such as hernias and myo-fascial pain disorders.

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