Testicular Pain: Or something else? Differential Diagnosis

Congenital malformations, deformities, and chromosomal abnormalities (Q00-Q99).

  • Sliding testis (retentio testis prescrotalis; gliding testis).
  • Inguinal testis (Retentio testis inguinalis; “cryptorchidism“).
  • Pendulum testis (“retractile testis”).

Cardiovascular system (I00-I99)

  • Polyarteritis nodosa – the classic form of polyarteritis nodosa (PAN) is a severe general disease (weight loss, fever, night sweats/nocturnal sweating, “chlorotic marasmus”) occurring either insidiously or post- or parainfectious, associated with systemic vasculitis (vascular inflammation).
  • Varicocele (varicocele hernia; synonyms: varicocele testis; varicocele hernia) – varicose vein formation in the area of the pampiniform plexus formed by the testicular and epididymal veins, a plexus of veins in the spermatic cord (lat. funiculus spermaticus); in a high percentage (75-90%), the varicocele occurs on the left side.Surgical indication: varicocelectomy if, in addition to the varicocele, there is also a reduced testis. The threshold is a testicular atrophy index (TAI) of 20%, which means that one testicle is 20% smaller than the other; another factor is a volume difference of at least 2 ml between the two testicles.

Infectious and parasitic diseases (A00-B99).

Mouth, esophagus (food pipe), stomach, and intestines (K00-K67; K90-K93).

  • Inguinoscrotal hernia (inguinal hernia that appears inguinally, i.e., in the groin and continues into the scrotum (scrotum)), incarcerated (“pinched”) or strangulated (“strangled,” “strangled”), respectively

Musculoskeletal system and connective tissue (M00-M99).

  • Hip problems: labral lesion (injury to the articular lip of the hip) – if groin and hip pain are reported together, increasing with weight bearing, and not reproducible on genital palpation (palpation of the genitals), a hip MRI should be performed.Note: Intra-articular injections or physical therapy also relieve testicular pain in such cases; it may also disappear.

Neoplasms – tumor diseases (C00-D48).

  • Testicular carcinoma (testicular cancer)
  • Testicular tumors, unspecified (e.g., seminoma) [these are usually painless; however, hemorrhage may cause acute scrotum]

Symptoms and abnormal clinical and laboratory findings not elsewhere classified (R00-R99).

  • Pain, unspecified (referred pain/transferred pain: e.g., ureteral stone/ureteral calculus, spinal tumor; idiopathic (“without ascertainable cause”) chronic testicular pain, approximately 30% of cases with chronic testicular pain)

Genitourinary system (kidneys, urinary tract – sex organs) (N00-N99).

  • Epididymitis (inflammation of the epididymis) – Occurrence usually during puberty or early adolescence.
  • Epididymoorchitis – combined inflammation of the testis (orchis) and epididymis (epididymis).
  • Epididymid cyst
  • Haematocele (“blood hernia”; i.e., accumulation of blood in body cavities or tissue crevices).
  • Ureteral obstruction – sudden obstruction of the ureter, for example, by a ureteral stone (ureteral stone).
  • Testicular necrosis – death of testicular tissue by pinching off the blood supply; possible consequence of testicular torsion.
  • Testicular torsion (acute stem rotation of testis and epididymis with interruption of blood circulation and hemorrhagic infarction) – most common diagnosis in children and adolescents (10-20 years of age).
  • Testicular tuberculosis
  • Hydatid torsion – torsion (twisting) of the appendix testis (Morgagni hydatid); symptomatology corresponds to testicular torsion.
  • Hydrocele (hydrocele) – stasis of fluid in the tunica vaginalis testis (testicular sheath).
  • Malacoplakia – plaque-like, white-gray deposits in the area of the ureters (ureters) or sometimes the urinary bladder, which can also affect the testes; these occur mainly in the context of chronic urinary tract infections
  • Mumpsorchitis – special form of epididymoorchitis; complication of parotitis epidemica (mumps) in about 25% of patients who suffer a mumps disease after puberty; can occur unilaterally as well as bilaterally (unilateral as well as bilateral) / in up to 30% bilaterally.
  • Orchitis (testicular inflammation) – usually caused by viruses, rarely by bacteria; as mumps orchitis usually 4-7 days after parotitis (parotitis).
  • Prostatitis (prostatitis)
  • Spermatocele (seminal hernia) – a retention cyst (cyst formed due to an outflow obstruction), usually located on the epididymis, which contains sperm-containing fluid.

Injuries, poisoning, and other consequences of external causes (S00-T98).

  • Testicular trauma (testicular injury)

Operations