Epididymoorchitis physical examination

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Dima Nimri, M.D. [2]

The main focus of physical examination in patients with epididymoorchitis is scrotal and testicular examination. Signs that may be present include testicular swelling, tenderness on palpation, as well as erythema. Other signs include relief of pain upon elevation of the testis. Unlike patients with testicular torsion, patients with epididymoorchitis have an intact cremasteric reflex.

The following physical signs may be apparent upon examination of patient with epididymoorchitis:^[1][2][3][4]

• General appearance: Patients with epididymoorchitis usually look uncomfortable while seated
• Vital signs: fever and tachycardia may be present
• Scrotal and testicular examination: look for swelling or tenderness on palpation of the testicle or palpation of a tender spermatic cord, which is suggestive of epididymitis. There may also be an area of induration. In the later stages of epididymoorchitis, there may be scrotal wall erythema that mimics testicular torsion
• Cremasteric reflex: ipsilateral cremasteric reflex is usually intact in cases of epididymoorchitis
• Prehn’s sign: Epididymoorchitis usually has a positive Prehn’s sign, which is the relief of pain with elevation of the testicle
• Inguinal area examination: inguinal area is examined to look for hernias or swollen/tender lymph nodes
• Costovertebral angle tenderness or tenderness on palpation of the suprapubic region may reveal concomitant pyelonephritis and cystitis, respectively

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