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According to Prehn's sign, the physical lifting of the testicles relieves the pain of epididymitis but not pain caused by testicular torsion. [ 4 ] Negative Prehn's sign indicates no pain relief with lifting the affected testicle, which points towards testicular torsion which is a surgical emergency and must be relieved within 6 hours.
Conditions that may result in similar symptoms include testicular torsion, inguinal hernia, and testicular cancer. [1] Ultrasound can be useful if the diagnosis is unclear. [1] Treatment may include pain medications, NSAIDs, and elevation. [1] Recommended antibiotics in those who are young and sexually active are ceftriaxone and doxycycline. [1]
Testicular torsion may also be caused by trauma to the scrotum or exercise (in particular, bicycle riding); [10] however, only about 4–8% of cases are the result of trauma. [1] [2] There is thought to be a possible genetic basis for predisposition to torsion, based on multiple published reports of familial testicular torsion. [10]
Testicular torsion can happen in a number of ways. It can occur when you're working out, having sex, or even sleeping. It's most common between the ages of 12 and 18, but can happen at any age.
Symptoms of orchitis are similar to those of testicular torsion. These can include: [citation needed] hematospermia (blood in the semen) hematuria (blood in the urine) severe pain; visible swelling of a testicle or testicles and often the inguinal lymph nodes on the affected side.
Chronic scrotal pain (pain for greater than 3 months) may occur due to a number of underlying conditions. [3] It occurs in 15-19% of men post vasectomy, due to infections such as epididymitis, prostatitis, and orchitis, as well as varicocele, hydrocele, spermatocele, polyarteritis nodosa, testicular torsion, previous surgery and trauma. [3]
Testicular torsion is a medical emergency. This is because the longer it takes to access medical intervention with respect to extending ischemia, the higher the chance that the testicle will be lost. There is a 90% chance to save the testicle if de-torsion surgery is performed within six hours of testicular torsion onset. [32]
The cremasteric reflex may be absent with testicular torsion, upper and lower motor neuron disorders, as well as a spine injury of L1-L2. It can also occur if the ilioinguinal nerve has accidentally been cut during a hernia repair. [4] The cremasteric reflex can be helpful in recognizing testicular emergencies.