Makindo Medical Notes

⚠️ Causes of Scrotal Pain and Lumps in Adults

• 🎢 Testicular Torsion:
  • 💥 Sudden, severe scrotal pain with swelling and erythema.
  • ❌ Absent cremasteric reflex, high-riding testicle.
  • 🧪 Diagnosis: Urgent clinical exam + Doppler US (reduced blood flow).
  • 💉 Management: Emergency surgery (detorsion & orchiopexy). Orchiectomy if non-viable.
• 🔥 Epididymo-orchitis:
  • Gradual onset unilateral pain, swelling, fever.
  • STIs (younger men) vs UTIs (older men).
  • 🧪 Tests: Urine culture, STI screen, US to exclude torsion.
  • 💊 Management: Antibiotics (ceftriaxone + doxycycline / ciprofloxacin), rest, NSAIDs, scrotal support.
• 🎯 Testicular Cancer:
  • Painless, firm lump (most common presentation).
  • ± Dull ache, heaviness, systemic symptoms (weight loss, back pain).
  • 🧪 Tests: Scrotal US (solid mass), tumour markers (AFP, β-hCG, LDH), CT staging.
  • 🩺 Management: Radical orchiectomy ± chemo/radiotherapy depending on type/stage.
• 🪢 Varicocele:
  • Dull, aching pain, worse with standing.
  • “Bag of worms” feel, usually left-sided. Infertility link.
  • 🧪 Test: Scrotal US with Doppler (venous dilation).
  • ⚕️ Management: Conservative if mild; varicocelectomy if painful, infertile, or atrophy.
• 📦 Inguinal Hernia:
  • Intermittent groin/scrotal swelling, reducible, worse on straining.
  • Severe pain if incarcerated/strangulated.
  • 🧪 Diagnosis: Clinical; US if unclear.
  • ⚕️ Management: Elective herniorrhaphy if uncomplicated; urgent repair if strangulated.

👶 Causes of Scrotal Pain and Lumps in Children

• 🎢 Testicular Torsion:
  • Acute severe pain, swelling, high-riding testicle, absent cremasteric reflex.
  • 🧪 Tests: Clinical diagnosis; Doppler US if doubt (do NOT delay surgery).
  • 💉 Management: Emergency surgery within 6 hours to save testis.
• 🔥 Epididymitis:
  • Gradual scrotal pain & swelling with fever.
  • Often post-UTI in boys.
  • 🧪 Tests: Urinalysis, urine culture, US to rule out torsion.
  • 💊 Management: Antibiotics, NSAIDs, rest, scrotal elevation.
• 💧 Hydrocele:
  • Painless, smooth swelling; transilluminates.
  • Often fluctuates in size.
  • 🧪 Diagnosis: Clinical ± US if uncertain.
  • ⚕️ Management: Usually resolves by age 1-2; surgical hydrocelectomy if persistent.
• 📦 Inguinal Hernia:
  • Reducible lump, enlarges with crying/straining.
  • Severe pain if incarcerated.
  • 🧪 Tests: Clinical, US if unclear.
  • ⚕️ Management: Surgical repair (elective vs urgent if strangulated).
• 🔵 Torsion of Appendix Testis:
  • Moderate acute pain, “blue dot sign” on scrotal skin.
  • Localized tenderness at upper pole.
  • 🧪 Tests: Doppler US (normal testicular blood flow).
  • ⚕️ Management: Conservative (NSAIDs, rest); resolves in ~1 week.
• 🪢 Varicocele:
  • Usually left-sided, dull ache, “bag of worms.”
  • May cause testicular atrophy or infertility later.
  • 🧪 Test: Doppler US.
  • ⚕️ Management: Conservative if mild; surgical repair if symptomatic or atrophic.

💡 Key OSCE Tip: Acute severe scrotal pain in a child = torsion until proven otherwise → immediate surgical exploration (do not delay for imaging).