Testicular pain and swelling

Question 1

What investigation should be performed if you suspect testicular torsion

Answer 1

The patient needs emergency surgery. This should not be delayed for any investigation. Urine dipstick is a quick and simple investigation and can be performed with other routine observations. It is usually normal in torsion. Ultrasound of the scrotum should not be performed in this patient.

Question 2

What is the main differential diagnosis of acute onset testicular pain

Answer 2

The main differential diagnosis is that of epididymo-orchitis

But

A VERY rapid onset of pain should lead you to a diagnosis of torsion until proven otherwise.

Question 3

Differentiate testicular torsion pain and hydratid of morgagni torsion

Answer 3

The hydatid of Morgagni is a remnant of the Mullerian duct. The pain is usually less intense and the whole testicle should not be involved

Question 4

When can testicular torsion occur, and what is most common age group

Answer 4

Testicular torsion can occur in any age group, but the most common group is 11-30 years. It is less common after 30years

Question 5

What is the history of a patient with testicular torsion

Answer 5

These patients often have a history of intermittent testicular pain where the testicle has torted and spontaneously untorted. Surgery should not be delayed.

Question 6

What is the salvage rate of a torted testis

Answer 6

The salvage rate is 100% within 6 hours, but this drops to approximately 20% at 12 hours and 0% after 24 hours.

Question 7

What should happen to the other testis during surgery

Answer 7

Both testes should be fixed at surgery to reduce the risk of subsequent torsion.

Question 8

What will the history of epididymo-orchitis be?

Answer 8

The patient will often have a history of gradual onset of pain and there are often associated urinary symptoms. The pain may be localised to the epididymis or may involve the scrotum.

Question 9

What causes epididymitis

Answer 9

Epididymitis is usually due to retrograde extension of bacteria from the vas deferens. There is usually a causative organism and this is age dependant

Question 10

What is the usual cause of epididymitis in:
Children
Young men <35 y/o
Men >35 y/o

Answer 10

In children, there is often an underlying congenital abnormality. The most common causative organism is E. Coli.

In young men <35years, the most common causative organism is Chlamydia, followed by N. gonorrhoea.

In men >35years, Coliforms are more common.

Question 11

Which imaging is used to look for stones vs tumours

Answer 11

NON-CONTRAST CT KUB (Kidney Ureter Bladder) is used to detect stones, it is an un-enhanced study which does not use contrast.

CT IVU does use contrast and is used to investigate for tumours.