Testicular Pain

Age: ‍ years old

Gender: male



HISTORY:

Presents with a ‍-‍day history of testicular pain

Onset was ‍gradualsudden, started ‍whileafter ‍

Location is on ‍rightleft testicle

Radiation ‍none to ‍

Rated at ‍012345678910 / 10 ‍

Described as ‍dullaching

Pattern ‍constantintermittent

Episodes last for ‍ ‍, recur ‍ times per ‍

Worsening factors: ‍none

Alleviating factors: ‍none, ‍effectiveineffective



Associated symptoms: *Try using right-click for negatives*

‍swelling

‍redness

‍fever, up to ‍°, over ‍ ‍hoursdays

‍abdominal pain, ‍diffuse, ‍dull, ‍mild

‍nausea

‍vomiting, ‍ episodes ‍per day, ‍, ‍hematemesis

‍hematuria

‍dysuria

‍urinary frequency



Contributing factors:

‍sexually transmitted infections

‍recent trauma

‍heavy physical activity

no history of: ‍testicular torsion, ‍epididymitis, ‍orchitis, ‍hydrocele, ‍varicocele, ‍inguinal hernia, ‍previous testicular surgery





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Abdomen: ‍soft, ‍non-tender ‍, ‍non-distended, ‍guarding, bowel sounds ‍normal, ‍, ‍CVA tenderness ‍

Genital: penis ‍normal, testes and epididymis ‍normal, ‍inguinal hernia





ASSESSMENT:

‍Epididymitis ‍likelysuspectedpossible

DDx: epididymitis, orchitis, testicular torsion, inguinal hernia, testicular trauma, hydrocele, varicocele, testicular cancer, renal colic, kidney stones, herniated lumbar disc with referred pain, mumps orchitis, idiopathic scrotal pain, spermatocele, epididymal cyst, Fournier's gangrene, prostatitis, sexually transmitted infections





PLAN:

Investigations:

- Urinalysis

- Urine culture

- STI testing for chlamydia and gonorrhea

- Blood work: ‍CBC, ‍CRP, ‍creatinine

- Scrotal ultrasound

- Testicular doppler if torsion suspected

Treatments:

- ‍Analgesics

- ‍Antibiotics

- Ice packs

Further care:

- Referral to urologist

- Follow-up in ‍ ‍daysweeks

- Return if pain worsens, if new symptoms develop such as fever or swelling, or if symptoms do not improve with treatment

- Referral to ER if severe pain or sudden onset of symptoms occurs