Pain in the testicles in case of epididymitis | Pain in the testicles

Pain in the testicles in case of epididymitis

Epididymitis can also cause pain in the testicles. Most often epididymitis is caused by ascending infections originating in the prostate, the seminal duct or the urethra.Various bacteria can be pathogenic (chlamydia, gonococcus, E. coli, staphylococci). More rarely, the trigger is a spreading infection via the bloodstream or a traumatic experience.

Also a congestion of urine back into the vas deferens to the epididymis can trigger epididymitis. The symptoms are acute severe pain in the scrotum. The epididymis swells up considerably and the entire scrotal skin is reddened.

The pain can also radiate into the groin region and the lower abdomen. There may also be signs of a urinary tract infection and fever. As with orchitis, the diagnosis is made on the basis of the medical history and a urological examination.

Care must be taken to ensure that the epididymis can swell to such an extent that it can no longer be distinguished from the testis. The so-called Prehn’s sign is considered a pioneering sign. Here the examiner lifts the testicle.

If the pain decreases, this indicates an inflammation of the epididymis. If the pain remains or increases, this is considered to be the differential diagnosis of testicular torsion. An ultrasound can also be performed to detect possible abscesses.

The blood shows an increased number of leukocytes, which indicate the inflammation (leukocytosis). Antibiotics (e.g. Levofloxacin, Tavanic or Ofloxacin) are prescribed as a therapy for bacterial epididymitis. Antiphlogistics can also be taken to reduce the inflammation. The testicles should be elevated slightly and bed rest should be observed.

  • Symptoms
  • Diagnosis
  • Therapy

Pain in the testicles in case of testicular torsion

In testicular torsion the testis is extremely mobile within its enveloping structures (tunica vaginalis testis) and can thus rotate around the spermatic cord. The venous plexus pampiniformis is compressed and this can lead to a backlog of blood and thus to a hemorrhagic testicular infarction. Testicular torsion is an event which mainly affects children.

Predominantly it occurs in infants or adolescents at the age of 15 – 20 years. The main symptom of testicular torsion is the acute and very initial pain in the testicles, which radiates into the groin and abdomen. In addition, swelling (edema) and reddening of the testicles may occur.

Furthermore, accompanying symptoms can also occur. Such would be nausea and vomiting or possibly shock symptoms. In order to make a reliable diagnosis, a medical history and urological examination are first carried out.

In the case of the Brunzel sign, there is a unilateral undescended testicle, since the spermatic cord is somewhat shortened due to rotation. The testis is also extremely sensitive to pressure and the cremasteric reflex is suspended. The Prehn’s sign is negative to distinguish an inflammatory reaction of the testis.

This means that in comparison with testicular torsion, the pain of the testis remains the same or may even increase when the testis is lifted (in epididymitis, the pain is cancelled out when the testis is lifted). In addition, an ultrasound of the testicle can be made. This should always be performed on both sides, even if the event is unilateral.

The differential diagnosis of a hydrocele can be excluded or the blood vessels and blood supply can be visualized by means of Doppler sonography. In the case of testicular torsion the venous return flow is missing due to the disconnection. Therapy Testicular torsion is a urological emergency and requires immediate therapy.

At first, a manual attempt can be made to re-torsion the testicle. In doing so, the physician turns the left testicle clockwise and the right testicle counterclockwise to restore the original situation. Afterwards, however, the testicle must always be surgically attached (orchidopexy).

Both testicles are attached, even the one that was not affected. This is to prevent a recurrence. If torsion of the testis cannot be excluded with certainty, the testis must always be exposed.

The operation should generally be performed less than 6 hours after the occurrence of the event, otherwise the tissue will die irreversibly. It has been proven that after 12 hours without therapy, irreversible necrosis has already occurred in 80% of cases. Therefore, acute and devastating testicular pain always requires rapid clarification and initiation of therapy.

The Prehn’s sign is negative to distinguish an inflammatory reaction of the testis. This means that in comparison with testicular torsion, the pain of the testis remains the same or may even increase when the testis is lifted (in the case of epididymitis, the pain disappears when the testis is lifted). In addition, an ultrasound of the testicle can be made.This should always be done on both sides, even if the event is one-sided.

The differential diagnosis of a hydrocele can be excluded or the blood vessels and blood supply can be visualized by means of Doppler sonography. In the case of testicular torsion the venous return flow is missing due to the disconnection. Testicular torsion is a urological emergency and requires immediate therapy.

At first, a manual attempt can be made to re-torsion the testicle. In doing so, the physician turns the left testicle clockwise and the right testicle counterclockwise to restore the original situation. Afterwards, however, the testicle must always be surgically attached (orchidopexy).

Both testicles are attached, even the one that was not affected. This is to prevent a recurrence. If torsion of the testis cannot be excluded with certainty, the testis must always be exposed.

The operation should generally be performed less than 6 hours after the occurrence of the event, otherwise the tissue will die irreversibly. It has been proven that after 12 hours without therapy, irreversible necrosis has already occurred in 80% of cases. Therefore, acute and devastating testicular pain always requires rapid clarification and initiation of therapy.

  • Symptoms
  • Diagnosis
  • Therapy