Testicular pain should always be considered urgent because of possible Fourniers Gangerene or testicular torsion. Cancer is a common fear in patients.

• Epididymal or testicular appendage torsion
• Epididymysis
• Fournier’s Gangrene
• Henoch-Schönlein purpura
• Hydrocele
• Peritonitis
• Referred pain due to an incarcerated hernia, constipation or kidney stone
• Ruptured abdominal aneurysm
• Scrotal trauma
• Testicular torsion
• Tumor

• History and physical exam includes abdomen, back, genitalia and digital rectal exam.
• Note: Onset, duration, location, quality and any other instances of pain
• Transilluminate for fluid
• “Blue dot sign” -> Blue coloration along upper area seen in 20% of torsion of the testicular appendix and/or due to infarction or necrosis.
• Palpate testicle and spermatic cord for:

• Effusion
• Tenderness
• Subcutaneous emphysema
• Size

• Neisseria gonorrhoeae and Chlamydia trachomatis culture
• Urinalysis in all patients

• Recent studies support the use of MRI

• Use doppler to check for masses

• Epididymitis

• Antibiotic therapy
• NSAIDs and scrotal elevation

• UTI

• Antibiotic therapy

• Tumor

• Resection

• Testicular torsion is an emergency

• Necessary to salvage testicle
• If surgery is not available, perform manual detorsion

• Penetrate spermatic cord with 10-20mL of 1% lidocaine
• Gently twist testes to the left and right
• Patient will feel immediate relief upon detorsion
• Refer to a to a urologist if unsuccessful

• Incarcerated inguinal hernias and testicular rupture involve surgery