Evaluation of acute scrotal pain in adults
- Robert C Eyre, MD
Robert C Eyre, MD
- Associate Professor of Surgery
- Harvard Medical School
The spectrum of conditions affecting the scrotum and its contents ranges from acute pathologic events that require immediate surgical intervention to incidental findings that simply require patient reassurance.
This topic addresses the clinical evaluation and management of the acute scrotum, which is defined as moderate to severe scrotal pain that develops over the course of minutes to one to two days, in adults. Nonacute scrotal conditions in adults and scrotal disorders in children and adolescents are discussed separately. (See "Evaluation of nonacute scrotal conditions in adults" and "Evaluation of scrotal pain or swelling in children and adolescents".)
The testis, tunica vaginalis, epididymis, spermatic cord, and appendix testis are anatomic structures that may be involved in scrotal pathology (figure 1):
●The testis (testicle) is the male gonad responsible for production of sperm and androgens (primarily testosterone).
●The tunica vaginalis is a potential space that encompasses the anterior two-thirds of the testis. Different types of fluid may accumulate within the tunica vaginalis (eg, water with a hydrocele, blood with a hematocele, pus with a pyocele).
- Rabinowitz R. The importance of the cremasteric reflex in acute scrotal swelling in children. J Urol 1984; 132:89.
- Trojian TH, Lishnak TS, Heiman D. Epididymitis and orchitis: an overview. Am Fam Physician 2009; 79:583.
- Stewart A, Ubee SS, Davies H. Epididymo-orchitis. BMJ 2011; 342:d1543.
- Tracy CR, Steers WD, Costabile R. Diagnosis and management of epididymitis. Urol Clin North Am 2008; 35:101.
- Doble A, Taylor-Robinson D, Thomas BJ, et al. Acute epididymitis: a microbiological and ultrasonographic study. Br J Urol 1989; 63:90.
- Hawkins DA, Taylor-Robinson D, Thomas BJ, Harris JR. Microbiological survey of acute epididymitis. Genitourin Med 1986; 62:342.
- Workowski KA, Bolan GA, Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep 2015; 64:1.
- Wampler SM, Llanes M. Common scrotal and testicular problems. Prim Care 2010; 37:613.
- Molokwu CN, Somani BK, Goodman CM. Outcomes of scrotal exploration for acute scrotal pain suspicious of testicular torsion: a consecutive case series of 173 patients. BJU Int 2011; 107:990.
- Cummings JM, Boullier JA, Sekhon D, Bose K. Adult testicular torsion. J Urol 2002; 167:2109.
- al Mufti RA, Ogedegbe AK, Lafferty K. The use of Doppler ultrasound in the clinical management of acute testicular pain. Br J Urol 1995; 76:625.
- Watkin NA, Reiger NA, Moisey CU. Is the conservative management of the acute scrotum justified on clinical grounds? Br J Urol 1996; 78:623.
- Tajchner L, Larkin JO, Bourke MG, et al. Management of the acute scrotum in a district general hospital: 10-year experience. ScientificWorldJournal 2009; 9:281.
- Hegarty PK, Walsh E, Corcoran MO. Exploration of the acute scrotum: a retrospective analysis of 100 consecutive cases. Ir J Med Sci 2001; 170:181.
- Dunne PJ, O'Loughlin BS. Testicular torsion: time is the enemy. Aust N Z J Surg 2000; 70:441.
- Jarow JP, Sanzone JJ. Risk factors for male partner antisperm antibodies. J Urol 1992; 148:1805.
- Schmitz D, Safranek S. Clinical inquiries. How useful is a physical exam in diagnosing testicular torsion? J Fam Pract 2009; 58:433.
- Wilbert DM, Schaerfe CW, Stern WD, et al. Evaluation of the acute scrotum by color-coded Doppler ultrasonography. J Urol 1993; 149:1475.
- Kapasi Z, Halliday S. Best evidence topic report. Ultrasound in the diagnosis of testicular torsion. Emerg Med J 2005; 22:559.
- Pepe P, Panella P, Pennisi M, Aragona F. Does color Doppler sonography improve the clinical assessment of patients with acute scrotum? Eur J Radiol 2006; 60:120.
- Liguori G, Bucci S, Zordani A, et al. Role of US in acute scrotal pain. World J Urol 2011; 29:639.
- Sessions AE, Rabinowitz R, Hulbert WC, et al. Testicular torsion: direction, degree, duration and disinformation. J Urol 2003; 169:663.
- Perron CE. Pain--Scrotal. In: Textbook of Pediatric Emergency Medicine, 4th ed, Fleisher GR, Ludwig S (Eds), Lippincott, Williams & Wilkins, Philadelphia 2000. p.473.
- Palestro CJ, Manor EP, Kim CK, Goldsmith SJ. Torsion of a testicular appendage in an adult male. Clin Nucl Med 1990; 15:515.
- Fisher R, Walker J. The acute paediatric scrotum. Br J Hosp Med 1994; 51:290.
- Ringdahl E, Teague L. Testicular torsion. Am Fam Physician 2006; 74:1739.
- Kadish HA, Bolte RG. A retrospective review of pediatric patients with epididymitis, testicular torsion, and torsion of testicular appendages. Pediatrics 1998; 102:73.
- Hesser U, Rosenborg M, Gierup J, et al. Gray-scale sonography in torsion of the testicular appendages. Pediatr Radiol 1993; 23:529.
- Shah J, Qureshi I, Ellis BW. Acute idiopathic scrotal oedema in an adult: a case report. Int J Clin Pract 2004; 58:1168.
- Ooi DG, Chua MT, Tan LG. A case of adult acute idiopathic scrotal edema. Nat Rev Urol 2009; 6:331.
- McGee SR. Referred scrotal pain: case reports and review. J Gen Intern Med 1993; 8:694.
- NORMAL ANATOMY
- PATIENT EVALUATION
- General approach
- - Diffuse scrotal pain
- - Localized scrotal pain
- Additional evaluation
- COMMON ETIOLOGIES
- Acute epididymitis or epididymo-orchitis
- - Clinical features and diagnosis
- - Management
- Testicular torsion
- - Clinical features and diagnosis
- - Management
- Manual detorsion
- LESS COMMON ETIOLOGIES
- Fournier's gangrene
- Torsion of the appendix testis
- Post-vasectomy pain
- Inguinal hernia
- Mumps orchitis
- Testicular cancer
- Henoch-Schönlein purpura
- Acute idiopathic scrotal edema
- Referred pain
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS