Makindo Medical Notes Comprehensive Medical Encyclopedia | Education for Healthcare Professionals

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Scrotal/testicular pain and/or lump/swelling (Children/Adults)

⚠️ 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).

PLEASE NOTE LEGAL ADVICE: The contents are under continuing development and improvements and may contain errors of omission or fact. Feedback vital and always welcome at drokane at gmail.com. This is not to be used for the assessment, diagnosis or management of patients. It should not be regarded as medical advice. It is only for educational purposes. Please adhere to your local protocols. If you are unwell please seek healthcare advice from your doctor. This does not replace senior or specialist advice. If you do not accept this then please do not use the website. If you need medical advice, please consult a doctor or other appropriate medical professional. If you are a medical professional and you need advice then speak to your senior or colleagues.

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