Scrotal pain

Scrotal pain

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  Pathology within the scrotum
  • 
    
    Torsion of the testicles 
  • 
    
    Torsion of testicular appendages
  • 
    
    Epididymo-orchitis
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    Testicular tumour
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  Referred pain
  • 
    
    Ureteric colic

Testicular torsion: ischaemic pain is severe (e.g. myocardial infarction, ischaemic leg, ischaemic testis). Torsion presents with sudden onset of pain in the hemiscrotum, sometimes waking the patient from sleep. May radiate to the groin and/or loin. There is sometimes a history of mild trauma to the testis in the hours before the acute onset of pain. Similar episodes may have occurred in the past, with spontaneous resolution of the pain (suggesting torsion/spontaneous detorsion). The testis is very tender. It may be high-riding (lying at a higher than normal position in the testis) and may lie horizontally due to twisting of the cord. There may be scrotal erythema.

Epididymo-orchitis: similar presenting symptoms as testicular torsion. Tenderness is usually localized to the epididymis (absence of testicular tenderness may help to distinguish epididymo-orchitis from testicular torsion, but in many cases it is difficult to distinguish between the two).

Testicular tumour: 20% present with testicular pain.

Acute presentations of testicular tumours

• Testicular swelling may occur rapidly (over days or weeks). An associated (secondary) hydrocele is common. A hydrocele in a young person should always be investigated with an ultrasound to determine whether the underlying testis is normal.
• Rapid onset (days) of testicular swelling can occur. Very rarely present with advanced metastatic disease (high volume disease in the retroperitoneum, chest, and neck causing chest, back, or abdominal pain or shortness of breath).
• Approximately 10 to 15% of testis tumours present with signs suggesting inflammation (i.e. signs suggesting a diagnosis of epididymo-orchitis: a tender, swollen testis, with redness in the overlying scrotal skin and a fever).