Emergency Med Medical News about testicular pain; testicular torsion

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A young man with acute onset of testicular pain
JAAPA, 08/04/09

Vajnar J – A 23–year–old male presented to the emergency department with complaints of testicular pain on the right side. The pain had come on suddenly 4 to 5 days previously and had gotten slightly better since then, but he still had swelling. He denied any fever or trauma. He said he did not seek treatment earlier because he was embarrassed and hoped the pain would resolve without medical help. The physical examination revealed swelling and redness of the scrotum. The right testicle was tender and slightly elevated compared to the left. The results of urinalysis and other laboratory tests were negative. Testicular ultrasonography (US) was performed...Prompt diagnosis of testicular torsion is important. Treatment consists of immediate surgery, and if this can be provided within 6 to 8 hours of the onset of symptoms, the chances of salvaging the testicle are nearly 100%. After 24 hours, however, the salvage rate drops to nearly zero. If the testicle is salvageable, bilateral orchiopexy, in which both testicles are fixed to the scrotum, is performed to prevent retorsion and to address the risk that the other side will torse as well. Even if spontaneous detorsion occurs, surgery is required to prevent recurrence. In some cases, manual detorsion can be performed before surgery for the temporary relief of pain and to reestablish blood flow to the testicle, but this procedure does not obviate the need for surgical correction.

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