| Diagnosis |
Symptoms |
PE/Consultation |
| Testicular Torsion |
- Unilateral, significant pain, usually constant
- Abrupt onset of symptoms, usually < 12 hrs
- Lower abdominal pain, nausea may be present
- No dysuria
- Neonates and peri- or pubertal teens
|
- Unilateral, tender scrotal swelling
- Induration, enlarged testis
- High riding testis or horizontal lie
- Absent cremasteric reflex
-
- Urology Consult
|
| Intermittent Testicular Torsion |
- Intermittent, sudden onset, sharp, unilateral pain that resolves quickly (minutes)
|
- Normal PE
-
- Consider Urology Consult
|
| Torsion of Appendix Testis or Appendix Epididymis |
- Unilateral, sudden onset
- No abdominal pain, nausea, dysuria
|
- Nontender testicle, normal size, normal lie
- Tenderness at superior pole, but can also be at inferior pole
- Gangrenous appendix may appear through scrotal skin as “blue dot” sign
- Normal cremasteric reflex
-
- Outpatient Urology follow-up as clinically indicated
|
| Epididymitis |
- Subacute onset
- Dysuria, frequency may be present
- Urethral discharge may be present
- Structural anomalies (ectopic ureter) in prepubertal males may result in bacterial infection
- Chlamydia is the most common cause in post-pubertal males
- Viruses, mycoplasma is a cause in all ages
|
- Scrotal edema, with or without erythema
- Swelling of epididymis
- Normal testicular lie
- Normal cremasteric reflex
- Prehn’s sign -decreased pain with elevation of testis
- Positive urinalysis in post-pubertal child requires antibiotics
|
| Hydrocele |
- Inguinal and/or scrotal swelling
|
- Usually nontender
- Can be tender if large and acute
-
- Outpatient Urology follow-up
|
| Incarcerated Hernia |
- Inguinal mass, not reducible
- Pain, abdominal pain/distention
- Poor PO or vomiting
|
- Firm, inguinal mass
- Usually tender
-
- General Surgery Consult
|
| Varicocele |
- Intermittent, achy scrotal pain (usually left)
- No abdominal pain, nausea, vomiting
- Most often in adolescents
|
- Dilated veins around spermatic cord
- Increased varicocele with Valsalva
- Normal testis
-
- Outpatient Urology follow-up as clinically indicated
|
| Vasculitis HSP |
- Can cause scrotal pain, acute or subacute
|
- Swelling and tenderness of scrotum
- Erythema of overlying skin and typical purpuric lesions may be present
|
| Orchitis |
- Unilateral pain
- May have fever
- Viral causes, i.e. mumps, coxsackie, etc.
|
- Scrotal swelling, tenderness, erythema
|
| Orchalgia |
- Non-specific, mild pain
- Common in puberty
- Review return precautions for possible intermittent torsion
|
- Normal PE
-
- Urology Consult as clinically indicated
|
| Tumor |
- Subacute, often painless testicular mass unless rapidly growing
|
- Enlarged testis
- Palpable testicular mass
- Scrotal swelling
-
- Urology Consult
|