The so-called acute scrotum is a collective term for all diseases that can lead to sudden pain or swelling of the testicles (scrotum). The diagnosis “acute scrotum” is therefore not to be assigned to a specific cause of disease, but is used as a working diagnosis which falls under a urological emergency and requires immediate clarification of the cause and immediate treatment. There are several possible causes that can cause the clinical picture of the acute scrotum.
The most serious cause is the so-called testicular torsion. This is a clinical picture in which the testicle rotates within its sheaths, which can lead to a pinching of the blood vessels supplying the testicular tissue. The cause of this rotation (torsion) is usually congenital factors, for example insufficient anatomical fixation of the testis in its sheaths, so that it is movable beyond the normal range, which ultimately promotes testicular torsion.
A testicular torsion is an absolute urological emergency, as the poor blood supply can cause irreversible damage to the testicular tissue after a short time. Although only about 25 percent of cases of an acute scrotum are caused by testicular torsion, it is nevertheless the most important cause which must be clarified in the case of an acute scrotum, as it can lead to severe damage within a short time and must therefore be treated quickly. Another common cause of an acute scrotum is an inflammation in the area of the testis. Several structures can be affected, such as the testicle itself (orchitis), the epididymis (epididymitis), the spermatic duct or the spermatic cord. Finally, traumas, i.e. violent impacts on the testicles, also cause an acute scrotum.
The main symptom of the acute scrotum is the acute onset of pain, usually very severe pain in the area of the testis, but which can also radiate into the groin. This pain is often of such intensity that it is also called pain of destruction. The pain can easily be provoked by touching or even pressure on the affected area (pressure dolence), but it usually occurs at rest.
Also typical for an acute scrotum is the accompanying swelling (scrotal edema). Frequently, redness also occurs over the affected area. An equally characteristic sign of an acute scrotum is that the symptoms are usually limited to the affected side of the testis and that the testis therefore shows the symptoms mentioned on one side.
Due to the extremely strong pain, the vegetative nervous system may be involved, which may result in accompanying nausea or even vomiting. The symptoms such as pain, reddening and swelling occur despite different causes for an acute scrotum, but are caused by different mechanisms. In testicular torsion, for example, the above-mentioned symptoms are directly caused by the cut-off of the blood supply.
In addition to this, there is sometimes an undescended testicle on the affected side, which can be explained by the rotation of the testis around its hanging structures and their resulting shortening. With inflammation, on the other hand, the symptoms are caused by inflammatory mediators, i.e. messenger substances in the body. These ensure that pain occurs and that the inflamed area is supplied with increased blood circulation.
This leads to reddening and the blood vessels become more permeable, which causes fluid to leak from the blood into the tissue and thus swelling of the testicles. It is also typical for an inflammatory cause of the acute scrotum that the pain does not usually begin as acutely as in a traumatic etiology or testicular torsion, but that it begins gradually and increases in intensity. In some cases of inflammation in the testicular area, fever may accompany the pain.