Acute scrotum is the term used to describe sudden and severe pain in the area of the testicles. These may also be accompanied by swelling. Various conditions may be the cause of acute scrotum.
What is acute scrotum?
The technical term for the scrotum is scrotum. Accordingly, the term “acute scrotum” includes various clinical pictures that are associated with acute pain in the scrotum. An acute scrotum is an emergency that always requires urological clarification. The causes of acute scrotum are manifold. Inflammation, trauma, tumors, or congenital malformations are all possible.
Causes
Acute scrotum is defined as sudden and severe pain in the testicular area. These may also be accompanied by swelling. Acute scrotum can be caused by various conditions. One cause is inflammation of the testicle. In this case, both the testicle itself (orchitis) can be inflamed, as well as the epididymis. If the epididymis is inflamed, it is called epididymitis. Orchitis is a feared complication of mumps infections. Inflammation of the vas deferens (deferentitis) and the spermatic cords (funiculitis) can also result in acute scrotum. Likewise, the scrotal skin, i.e., the skin of the scrotum, can also become inflamed. If this inflammation leads to a scrotal abscess, that is, a collection of pus in the tissues of the scrotum, it can result in an acute scrotum. Inflammation of the scrotum caused by ß-hemolytic group A streptococci is called erysipelas. Erysipelas of the scrotum is very painful and therefore often triggers acute scrotum. The term testicular torsion refers to the partial or complete rotation of the testicle around the vascular pedicle through which the vessels supplying the testicle pass. Testicular torsion always manifests itself in the form of acute scrotum. The same is true for the so-called hydatid torsion. This is a twisting of the testicular or epididymal appendages. Testicular torsion and hydatid torsion are usually preceded by a developmental anomaly. The clinical picture often develops at night. Triggers, however, are also minor trauma or physical activity such as sports or boisterous play in children. Other causes of acute scrotum include insect bites, acute lymphatic congestion, or scrotal edema. Lymphatic congestion is often the result of surgery on the scrotum or occurs in association with cancer of the testicles or prostate. Scrotal edema, or water retention in the scrotum, can be allergy-related or idiopathic, meaning without an identifiable cause.
Symptoms, complaints, and signs
The cardinal symptom of acute scrotum is severe pain in the scrotum. This may occur very suddenly or may increase slowly. In most cases, only one scrotal compartment is affected. Acute scrotum with involvement of both testicular compartments is rare. The pain is very severe and typically radiates to the groin region. In addition, in most cases, the scrotum is severely reddened and the skin of the scrotum is overheated. The affected side of the scrotum may be swollen.
Diagnosis and course
Acute scrotum is always a urologic emergency. Particularly if torsion of the testis is suspected, action must be taken quickly. Six to eight hours after torsion, the tissue of the testis becomes necrotic, which means it dies and then cannot be saved. In newborns, the time to necrosis is even much shorter. The consequence is the loss of one or possibly even both testicles. An extreme sensitivity of the testis to pressure is indicative of testicular torsion. To differentiate acute scrotum, the Prehn’s sign is used as a urological examination method. The physician lifts the affected testicle of the patient. The patient should lie as relaxed as possible on the examination couch. If the pain increases or remains the same when the testicle is lifted, the Prehn’s sign is negative. A negative Prehn’s sign indicates testicular torsion. If the pain decreases when the testicle is lifted, the Prehn’s sign is positive. A positive Prehn’s sign indicates inflammation of the testis or epididymis. The Prehn’s sign is suitable for obtaining an initial indication of a possible cause in the case of acute scrotum.However, this examination is not particularly reliable, so that further diagnostic measures must be taken. Possible indications of testicular torsion are also provided by the so-called cremasteric reflex. In the cremasteric reflex, an elevation of the equilateral testis is triggered by stroking the inner side of the thigh. If this elevation does not occur, testicular torsion may be present. In the clinic or physician’s office, color Doppler ultrasonography is usually performed immediately if torsion is suspected. This will show either reduced or normal to increased blood flow. Sonography can also be used to diagnose the other causes of acute scrotum. One hundred percent diagnostic certainty in suspected testicular torsion, however, is provided only by surgical exposure of the testicle.
Complications
Acute scrotum can cause several complications. First, the inflammation may spread to the testis and epididymis, accompanied by severe pain and feelings of pressure in the scrotum area. When touched, the symptoms usually intensify considerably and may be accompanied by nausea and fever symptoms. In the further course, there is a risk of compression of the testicle or thrombosis; both can lead in severe cases to testicular infarction and thus in the last consequence to the death of the testicle. Rarely, an acute scrotum can lead to compartment syndrome with severe pain in the scrotum, feelings of tightness, and sensory disturbances such as tingling and numbness. The development of chronic epididymitis is also a risk. If a serious, possibly chronic secondary disease develops from the acute scrotum, this can lead to infertility and other similarly severe complications. Fertility is usually also reduced after an acute scrotum. If the symptoms are treated early, however, serious complications can almost always be avoided. Nevertheless, there are risks associated with the treatment itself: allergic reactions to drugs, painful scrotal abscesses, and the formation of fistulas after surgical intervention.
When should you see a doctor?
In any case of acute scrotum, a doctor should be consulted. Even though the cause of the swelling may not be serious, an examination should always be performed. This can prevent irreversible consequential damage. As a rule, a doctor should be consulted if severe pain and swelling have occurred. In this case, the pain is mainly severe and stabbing, which can often spread to other regions of the body. If a so-called testicular torsion has occurred, a doctor must be consulted immediately. In this case, however, the patient can also turn to a hospital or call an ambulance. The earlier the treatment is initiated, the lower the risk of various consequential damages and potency restrictions. Medical treatment is also necessary in case of numbness in the region of soft tissues and testicles. If no treatment occurs, in many cases infertility occurs. This is usually irreversible and can continue to cause severe psychological discomfort and significantly reduce the patient’s quality of life.
Treatment and therapy
Treatment of acute scrotum depends on the cause. While surgery cannot be avoided for testicular torsion, symptoms of hydatid torsion usually decrease spontaneously within a few days and then disappear. Testicular and epididymitis require medical therapy with antibiotics. In addition, bed rest, elevation and cooling of the testicle are indicated. Inflammations of vas deferens or spermatic cords are also usually treated with antibiotics. Therapy of lymphedema of the scrotum by manual lymphatic drainage is often protracted and not always promising.
Outlook and prognosis
In most cases, patients with acute scrotum suffer from very severe pain in the testicles. This pain is extremely unpleasant for the man and in the process can spread to other regions of the body and cause discomfort there as well. As a rule, the further course of this disease strongly depends on the cause of the acute scrotum. Most often, the pain also radiates to the region of the groin. Likewise, there is a strong warming of the scrotum.Should this warming continue over a longer period of time, this can lead to impotence and thus to an inability to procreate. Not infrequently, this leads to psychological discomfort or even depression. Furthermore, there is also a strong swelling of the scrotum. The testicles themselves can feel numb or, in the worst case, even die. This is especially the case with the so-called testicular torsion. Treatment of acute scrotum is usually causal and symptomatic. The discomfort can be relieved with the help of painkillers. In case of inflammation, antibiotics are used. In most cases, this results in a positive course of the disease.
Prevention
As a rule, acute scrotum cannot be prevented. It is important to see a doctor immediately if there is severe pain in the testicular area, so that testicular torsion can be ruled out as the cause of acute scrotum.
Aftercare
Acute scrotum refers to severe pain in the testicular area. Thus, it is not an independent disease, but rather a symptom of an independent disease. In most cases, such an acute scrotum is due to an inflammation of the testicles, which can be effectively alleviated by appropriate medication. Subsequent follow-up after the disease has been overcome is very important and significant in order to detect and treat any recurrence of the inflammation at an early stage. If the affected person decides on medical or medical aftercare, then a complication-free course of the disease can be expected. Once the inflammation of the testicles has subsided, further visits to the doctor should be made. Only careful aftercare can reveal a renewed inflammation of the testicles at an early stage and bring about timely treatment. If the affected person decides against such follow-up, serious complications are to be expected. Under certain circumstances, the inflammation can spread throughout the entire body, so that there is even a risk of blood poisoning. An acute scrotum always requires professional and appropriate aftercare. In this way, unnecessary and serious complications can be avoided from scratch. The development of a new scrotum is nipped in the bud with follow-up care.
What you can do yourself
Acute scrotum is always an emergency situation that requires medical treatment. Depending on its cause, the acute pain can be relieved by some self-help measures and home remedies. For example, if the acute scrotum is due to a torsion or contusion of the testicle, the scrotum should be immobilized. The scrotum should not be moved to avoid further attacks of pain and twisting of the testicle. In addition, the affected person should be reassured and, if possible, distracted from the intense pain. Accompanying first aid measures can be the application of cold packs or cold compresses. Medicinal plants such as stinging nettle, valerian or lavender, which are either drunk or applied in the form of ointments, can also be used to relieve pain. These measures should always be taken in consultation with a doctor to avoid complications. After the acute pain has been relieved, the patient should go to the hospital for further evaluation. Sometimes it is necessary to treat an inflammation medically or to surgically move the testicle to its original position. In addition, the trigger for the acute scrotum must be determined. The doctor can then suggest further measures for acute pain relief and give tips for prevention.
