ACUTE TESTICULAR PAIN ACUTE TESTICULAR PAIN

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PRESENTATION OUTLINE PRESENTATION OUTLINE
Anatomy oI testis
DiIIerential diagnosis
ANATOMY OF TESTIS ANATOMY OF TESTIS
DeveIopment DeveIopment
develops in
retroperitoneum just
below the kidney
then descend to the
scrotum due to
several Iactors :
contraction oI
gubernaculum
maternal HCG
NormaI PosItIon NormaI PosItIon
lie vertically
head oI epididymis at
upper pole
epididymis lie posteriorly
Iood SuppIy Iood SuppIy
Arterial supply
testicular artery
directly Irom abdominal
aorta
Venous drainage
veins oI testes and epididymis
pampiniIorm plexus testicular
vein
ends in IVC on the right
ends in renal vein on the leIt
DIFFERENTIAL DIAGNOSIS DIFFERENTIAL DIAGNOSIS
%orsion
%esticular torsion
%esticular appendage torsion
InIection
Epididymo-orchitis
Inguino-scrotal hernia
%rauma
%esticular tumour
TestIcuIar TorsIon TestIcuIar TorsIon
Incidence
can occur in any age, but more Irequent in teenagers and young
adult
Predisposing Iactors
inversion oI testis
capacious tunica vaginalis
Exciting Iactor
minor trauma
straining
spontaneous
TestIcuIar TorsIon (cont.) TestIcuIar TorsIon (cont.)
$ymptom
sudden severe pain
/- nausea / vomiting
$ign
extreme tender and enlarged testicular region
overlying skin : edematous red
testis slightly higher than normal / horizontally
TestIcuIar TorsIon (cont.) TestIcuIar TorsIon (cont.)
Investigation
Urine analysia
Urgent doppler
%esticular scan
TestIcuIar TorsIon (cont.) TestIcuIar TorsIon (cont.)
anagement
deIinitive : surgery
prompt exploration untwisting Iixation
within 6hour Irom the onset
orchidectomy should be counselled and consented beIore
exploration
anatomical abnormality is bilateral contralateral ste
should be Iixed too
ormal
%wisted
Post procedure
TestIcuIar Appendage TorsIon TestIcuIar Appendage TorsIon
due to presence oI abnormal pedicle between epididymis and testis
torsion oI testis may occur along the axis oI this pedicle
Acute EpIdIdymo Acute EpIdIdymo--orcbItIs orcbItIs
ode oI inIection
usually ascending inIection Irom primary site
in outIlow obstruction secondary urinary inIection
in sexually active men $%I (gonorrhea / chlamydia)
genito-urinary abnormality
blood-borne (rare)
Acute EpIdIdymo Acute EpIdIdymo--orcbItIs orcbItIs
(cont.) (cont.)
Clinical Ieatures
penile discharge
Iever
swelling and pain over the testis and epididymis
scrotal skin : edematous and red
/- inguinal lymphadenopathy
Acute EpIdIdymo Acute EpIdIdymo--orcbItIs orcbItIs
(cont.) (cont.)
Investigation
Urine analysis
Urine culture
InIectious screening
Gonorrhea
Chlamydia
Herpes
HIV / HPV
Acute EpIdIdymo Acute EpIdIdymo--orcbItIs orcbItIs
(cont.) (cont.)
%reatment
bed rest and scrotal support
cold compress
a course oI antibiotic
pain killers
iI suppuration occur incision and drainage
TestIcuIar TorsIon (vs) TestIcuIar TorsIon (vs)
Acute EpIdIdymo Acute EpIdIdymo--orcbItIs orcbItIs
Testicular Testicular
Torsion Torsion
Acute Acute
Epididdymo Epididdymo
orchitis orchitis
Age Age Adolescents / Adolescents /
children children
Adults / elderly Adults / elderly
History History +/ +/ mild trauma mild trauma Usually UT! sx Usually UT! sx
Temperature Temperature Usually normal Usually normal Elevated Elevated
Elevation of Elevation of
scrotum scrotum
Not alleviate Not alleviate
pain pain
Partially relieve Partially relieve
pain pain
TestIcuIar TorsIon (vs) TestIcuIar TorsIon (vs)
Acute EpIdIdymo Acute EpIdIdymo--orcbItIs orcbItIs
Testicular Testicular
Torsion Torsion
Acute Acute
Epididdymo Epididdymo
orchitis orchitis
Urine analysis Urine analysis Free Free Nay show Nay show
leucocyte + leucocyte +
Doppler Doppler Obstructed Obstructed
testicular vessel testicular vessel
Patent Patent
StranguIated InguIno StranguIated InguIno--scrotaI scrotaI
HernIa HernIa
Clinical Ieatures
acute pain in hernia
irreducibility
intestinal obstruction iI the content involving intestine
the hernia is tense, tender, irreducible and have no impulse on
cough
Trauma Trauma
Clinical Ieatures
severe pain
may be associated with abrasion / laceration / bruises over the
scrotum
testicular swelling
testicular tenderness
Trauma (cont.) Trauma (cont.)
Investigation
Urine analysis
Doppler Ilow study
Doppler ultrasound
TestIcuIar Tumour TestIcuIar Tumour
usually patient presented with testicular lump
but, a minority oI patients may experience testicular pain
some cases may simulate epididymo-orchitis; the presents oI
urinary inection
Iailure to respond to antibiotic raises the possibility oI cancer
rarely, patient present with severe pain and acute enlargement oI
the testis because oI hemorrhage into the neoplasm
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