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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]
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.
The differential diagnosis of testicular pain is broad and involves conditions from benign to life-threatening. The most common causes of pain in children presenting to the emergency room are testicular torsion (16%), torsion of a testicular appendage (46%), and epididymitis (35%). [4] In adults, the most common cause is epididymitis. [citation ...
Hypergonadotropic hypogonadism (HH), also known as primary or peripheral/gonadal hypogonadism or primary gonadal failure, is a condition which is characterized by hypogonadism which is due to an impaired response of the gonads to the gonadotropins, follicle-stimulating hormone (FSH) and luteinizing hormone (LH), and in turn a lack of sex steroid production. [1]
Chronic testicular pain is long-term pain of the testes. [ 2 ] [ 3 ] It is considered chronic if it has persisted for more than three months. [ 1 ] Chronic testicular pain may be caused by injury , infection , surgery , cancer , varicocele , or testicular torsion , and is a possible complication after vasectomy . [ 2 ]
This is nearly diagnostic of this condition. If clinical suspicion is high for the serious differential diagnosis of testicular torsion, a surgical exploration of the scrotum is warranted. Torsion of the appendix of testis occurs at ages 0–15 years, with a mean at 10 years, which is similar to that of testicular torsion. [1]
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]
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.