Testicular concerns Flashcards
refractory scrotal pain despite adequate therapy for epididymitis should be evaluated for:
testicular torsion, testicular abscess or testicular infarction
can you tell the difference based on history or physical exam about the difference between testicular torsion, testicular abscess or testicular infarction?
no must get a additional imaging like a testicular U/S
testicular abscess
may not show fluctuance
testicular torsion is associated with
no cremasteric reflex but this is more common in boys <12 yrs cremasteric reflex test not reliable for ruling in or out testicular torsion in men
scrotal pain and swelling that is decreased with sac elevation may be
consistent with epididymitis but not specific to epididymitis
Needs to get U/S and urologist or radionucleotide scrotal imaging to see cause of pain to determine if he needs surgical management.
testicular cancer can present as
acute testicular pain.
bacterial causes of epididymitis based on age
<35 years see chlamydia and neisseria gonorrhea
>35 yrs see E coli and these are in men who engage in anal intercourse
common causes of epididymitis would be
chlamydia trachomatis - ok to treat with quinolones, macrolides, and doxycycline (low levels of in vivo resistance to these antibiotics)
when should pts start to feel better after being treated with epididymitis?
1-3 days and so continued pain should get further exploration of cause of pain.
does HIV and syphilis cause epididymitis pain?
no. more likely chlamydia but also consider other causes.
acute severe onset of pain, profound testicular swelling high riding testis bell clapper deformity
think testicular torsion which has pain in location of testis
screening test for testicular torsion?
U/S
epididymitis presentation
fever,
urinary frequency, urgency (acute)
induration, swelling, and exquisite tenderness of involved epididymis
pyuria and bacteruria on urinalysis
urine culture recommended
what do you order for someone who has epididymitis?
get urine culture
severe pain from anterior abdomen into scrotum and penis see skin edema and crepitus and blisters and bulla
fournier’s gangrene pain is diffuse scrotum