Let’s talk about common testicular emergencies, their characteristics and management. If you are a person who likes to learn (worry), you may want to read on; if not, just remember that “boys and men need to see a doctor immediately for scrotal swelling and pain” is enough, and leave the other complicated things to the doctor.
1. Testicular torsion
Sudden testicular pain and swelling, occasionally accompanied by nausea and vomiting, and possible pain in the iliac fossa, possibly related to physical activity. Discoloration of the scrotum, swelling and pressure in the testicle, elevated testicular position, and often loss of the testicular reflex.
Prompt surgical exploration (within 8-12 hours, some say within 4-6 hours) and repositioning may still be salvageable. The repositioned testicle requires a testicular fixation similar to cryptorchid surgery. More often than not, all that is seen is the necrotic testicle (below), which the surgeon has no recourse but to remove. In short, if testicular torsion is suspected, surgery should be performed without delay.
Is there a possibility of torsion of the opposite testicle in the future? The answer is yes, so most surgeons recommend prophylactic fixation of the contralateral testicle to avoid torsion later, in case there is an accident with the remaining testicle, the consequences can be very bad! The timing of the surgery for the fixation of the contralateral testicle is slightly more important, as it can be done at the same time when the inflammation is mild, but it is better to postpone it when the inflammation is severe.
2.Testicular attachment torsion
Gradually increasing testicular pain. The pressure point may be limited to the upper part of the testicle, and the “blue dot” may be seen through the scrotal skin, which is the necrotic testicular attachment. It is sometimes difficult to distinguish from testicular torsion. The pain may decrease after 48 hours with pain relief and usually disappears after 2-12 days. If it is difficult to identify, it is often necessary to explore surgically.
3.Epididymitis
It may start insidiously, with fever, vomiting and some urinary symptoms. It rarely occurs in prepubertal children, unless there is a genitourinary malformation itself, associated with a urinary tract infection. Mumps-associated orchitis occurs 4-6 days after the swelling of the parotid gland. The scrotum is red and swollen, and pressure is often on the posterior lateral aspect of the testicle. There may also be pus urine. Routine urine and urine culture are sent first, and then antibiotics are given. The painful discomfort in the scrotum may take several weeks to slowly improve.
4. Incarcerated hernia
There is a history of intermittent inguinal scrotal swelling. The mass is hard, painful on pressure, non-returnable, and swollen in the inguinal scrotal area. The contents must be returned, otherwise it will develop into a strangulated hernia with necrosis of the contents.
5.Primary scrotal edema
Painless, but rapid onset of significant edema. Scrotal edema can also be secondary to generalized edema. A slight purple swelling of the scrotum that continues into the penis and perineum, possibly bilateral, with no pressure on the testes. It usually resolves on its own in a few days and does not require treatment.
6. Sphingomyelomeningocele
Simple syringomyelia is easy to determine. The problem is that it can be seen in torsion, epididymitis, trauma or tumor. Redness and swelling of the scrotum in newborns, especially premature babies, requires attention to the problem of peritonitis. Soft, non-pressure swelling of the adjacent testis. Positive transillumination test. often heals spontaneously with self-closing of the sphincter within 1 year of age. If more than 2 years old, surgery should be performed.
7.Spermatic varicose vein
Abnormal dilatation of the spermatic veins in a mass. It is more common in teenage boys, on the left side. Individual children may have pain. It is like a mass of earthworms above the testicles, without pressure, and is more pronounced when standing. Surgery may be required.
8. Allergic purpura
Painful edema of the scrotum with a purple rash on the scrotum. Associated manifestations: There may also be a vascular rash on the buttocks and lower extremities, as well as arthritis, nephritis, and abdominal pain with gastrointestinal bleeding. It may be difficult to distinguish from testicular torsion in the absence of other related manifestations.
9. Rupture of the testicle or epididymis
History of trauma, such as straddling injuries, bicycle handlebar injuries, or sports injuries. Delayed onset of scrotal pain and swelling. Swollen and painful testicles on pressure. There may be contusion, edema, hematoma, or syringomyelia. Unless the testicle can be clearly palpated as normal and without significant pressure pain, surgical evaluation is required in the event of testicular injury.
10.Testicular tumor
Rapid enlargement with pain is associated with tumor bleeding or infarction. It is usually a unilateral painless hard mass. In case of leukemia infiltration, it may show on both sides.
11. Prenatal testicular torsion
Newborns may then exhibit a painless, smooth enlarged testicle. It is opaque and dark in color. The need for surgical management of testicular torsion in newborns is controversial because it occurs prenatally and whether the testicle can be saved varies greatly.