Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
Differentiating between testicular torsion and epididymitis in a patient presenting with acute scrotal pain is critical due to the emergency nature of testicular torsion NICE CKS.
Testicular Torsion:
- It is typically characterised by sudden-onset scrotal pain NICE CKS.
- Testicular torsion is a urological emergency, and if clinically suspected, immediate surgical exploration is necessary NICE CKS.
- If testicular torsion is suspected, the patient requires emergency hospital admission to urology or paediatric surgery NICE CKS.
- Surgical repair should ideally be performed within 4 hours to salvage the testicle NICE CKS.
- A history of previous episodes of severe, self-limiting scrotal pain or swelling may indicate spontaneous testicular torsion and detorsion, which warrants a urology referral NICE CKS.
Epididymitis:
- If an adolescent or adult has suspected epididymo-orchitis, emergency hospital admission is arranged if symptoms are severe, the person is systemically unwell, or there is a suspected serious complication NICE CKS.
- Serious complications that may require urgent ultrasound and/or hospital admission include testicular abscess or infarction NICE CKS.
- If hospital admission is not needed, management involves identifying the most likely causative organism based on the person's age, urine dipstick results, and risk factors NICE CKS.
- This may involve assessing the risk of a sexually transmitted infection (STI) or an enteric organism associated with a lower urinary tract infection (UTI) NICE CKS.
- If an STI is the most likely cause, urgent referral to a local specialist sexual health clinic is advised for testing, treatment, and possible contact tracing NICE CKS.
- If an enteric organism is the most likely cause, a urine dipstick test and mid-stream urine (MSU) sample for microscopy and culture should be arranged, and empirical antibiotic treatment may be considered NICE CKS.