Steven Doerr, MD, is a U.S. board-certified Emergency Medicine Physician. Dr. Doerr received his undergraduate degree in Spanish from the University of Colorado at Boulder. He graduated with his Medical Degree from the University Of Colorado Health Sciences Center in Denver, Colorado in 1998 and completed his residency training in Emergency Medicine from Denver Health Medical Center in Denver, Colorado in 2002, where he also served as Chief Resident.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
In order to diagnose the underlying condition causing testicular pain, a
complete history and physical exam will be performed by a health care
professional. Laboratory testing and imaging studies may also be ordered
depending on the health care professional's initial impression and evaluation.
a swab of the urethra (if the patient has penile discharge suggestive of a
sexually transmitted disease)
Imaging tests may include
Ultrasonography
A non-invasive imaging study that can evaluate the blood flow to the
testicles, as well as the presence of testicular tumors, fluid collections,
testicular rupture, hernias, and kidney stones (renal ultrasound).
Radionuclide imaging
An imaging study requiring the intravenous administration of a
radionuclide, useful for the evaluation of testicular torsion, as well as other
causes of testicular pain.
CT scan or a kidney/ureter/bladder (KUB) X-ray
These imaging studies are sometimes used for diagnosing kidney stones.
For certain testicular pain, such as those that are strongly suggestive of
testicular torsion, immediate urologic consultation prior to testing should be
obtained in order to prevent potential delays in definitive surgical management.
What is the treatment for testicular pain?
The treatment for testicular pain varies depending on the underlying cause.
As already noted, some conditions causing testicular pain are medical
emergencies requiring immediate surgical intervention.
Testicular torsion
Definitive management of testicular torsion requires surgery by a urologist.
During surgery, the affected testicle is untwisted, and if it is found to be
viable, the testicle is secured to the scrotal wall (orchiopexy). The unaffected
testicle may also be secured to prevent testicular torsion from occurring on the
other side.
Sometimes, the affected testicle can be manually untwisted by a physician
without necessitating emergent surgery, though this is a temporizing measure
that ultimately still requires definitive surgical repair. Likewise, some
testicular torsion can occur and then resolve spontaneously, and the health care
practitioner must maintain a high index of suspicion in order for this condition
to be diagnosed and ultimately surgically repaired.
The more rapidly the testicle is untwisted and blood flow is restored, the
better the chances for salvaging the affected testicle. If treated within 6
hours of symptom onset, the salvage rate nears 100%, while after 24 hours the
salvage rate is between 0% to 10%.
Epididymitis
The treatment of uncomplicated epididymitis can generally be managed as an
outpatient, and consists of the following treatment measures:
Antibiotics (which may vary depending on the patient's age and sexual
history), pain medication and anti-inflammatory agents
Rest
Scrotal support and elevation
Ice packs
In general, treated acute epididymitis resolves without complications.
However, in severe epididymitis associated with systemic symptoms or in those
accompanied by complications, hospitalization may be necessary.
Torsion of a testicular appendage
The treatment for torsion of the testicular or epididymal appendage is
directed toward relief of symptoms, and consists of the following measures:
Pain medication and anti-inflammatory agents
Rest
Scrotal support and elevation
Ice packs
Most patients improve with these treatment measures within 1 week, though
symptoms may last longer. In cases of testicular pain refractory to conservative
management, surgical excision of the affected tissue is considered.
Trauma
The treatment and management of testicular trauma depends on the severity of
injury. Minor cases of testicular trauma without suspected serious underlying
testicular injury can be managed as an outpatient with the following measures:
pain medication and anti-inflammatory agents;
rest;
scrotal support and elevation; and
ice packs.
With testicular rupture, immediate surgical repair is necessary to preserve
testicular function and viability. Other situations requiring surgical
management include certain blunt trauma injuries with associated hematoceles,
penetrating trauma, and certain cases of testicular dislocation.
Inguinal hernia
The definitive treatment of inguinal hernias requires surgical repair,
sometimes electively as an outpatient, while others require intervention on a
more emergent basis. Occasionally, inguinal hernias may not be repaired even
electively because a patient is too high-risk to undergo surgery.
Prompt surgical intervention is necessary in cases of inguinal hernias that
are not reducible (unable to be pushed back into the abdomen) and in those cases
of strangulation (disruption to the blood supply).
Orchitis
The treatment of orchitis depends on the infectious organism responsible for
causing the testicular inflammation. Both viral and bacterial orchitis can be
treated with the following measures:
pain medication and anti-inflammatory agents;
rest;
scrotal support and elevation; and
ice packs.
Bacterial orchitis and epididymo-orchitis require antibiotics. Those cases
caused by viruses do not require antibiotics.
Kidney stone
The treatment for kidney stones generally depends on the location of the
kidney stone, the size of the kidney stone, and any associated complications,
such as infection. An uncomplicated kidney stone can typically be treated with
the following measures:
adequate fluid intake;
pain medication;
anti- nausea medication; and
medications, such as tamsulosin (Flomax), which facilitate the passage of
kidney stones.
Several different measures exist for treating kidney stones that do not pass
spontaneously, such as lithotripsy (the use of shock waves to break up the
kidney stone) and other more invasive surgical procedures.
Certain patients with intractable pain, intractable vomiting or those with
signs of infection require hospitalization. In those with infection and
obstruction, antibiotics and emergent urologic intervention is necessary.
Testicular tumor
The treatment for a testicular tumor depends on various factors. A testicular
mass is considered cancer until proven otherwise. If testicular cancer is
diagnosed, patients are referred to an oncologist who will discuss the different
treatment options available.
Urinary tract infection (UTI) is an infection of the kidney, ureter, bladder, and/or urethra. Not
everyone with a UTI has symptoms. Common symptoms include a frequent urge to
urinate and a painful, burning when urinating.
Abdominal pain is pain in the belly and can be acute or chronic. Causes include inflammation, distention of an organ, and loss of the blood supply to an organ. Abdominal pain can reflect a major problem with one of the organs in the abdomen such as the appendix, gallbladder, large and small intestine, pancreas, liver, colon, duodenum, and spleen.
One in every 20 people develop a kidney stone at some point in their life. A kidney stone is a hard mineral and crystalline material formed within the kidney or urinary tract. Kidney stones symptoms and signs are, blood in the urine and pain in the abdomen, flank (lower back), or groin. A number of different conditions can lead to kidney stones including: gout, hypercalciuria, people with inflammatory bowel disease, kidney disease, and hypoparathyroidism. Some medications also increase the risk of kidney stones.
A hernia is an opening or weakness in the muscular structure of the wall of the abdomen. This defect causes a bulging of the abdominal wall. Symptoms of a hernia include pain or discomfort and a localized swelling somewhere on the surface of the abdomen or in the groin area.
Sexually transmitted diseases, or STDs, are infections that are transmitted during any
type of sexual exposure, including intercourse (vaginal or anal), oral sex, and
the sharing of sexual devices, such as vibrators. Although treatment exists for many STDs, others currently are
usually incurable, such as those caused by HIV, HPV, hepatitis B and C, and HHV-8.
Male sexual dysfunction can be caused by physical or psychological problems. Common sexual problems in men include erectile dysfunction (impotence or ED), premature ejaculation and loss of libido. Treatment for sexual dysfunction in men may involve medication, hormone therapy, psychological therapy, and the use of mechanical aids.
Mumps is an acute viral illness caused by the mumps virus. Symptoms of mumps include fever, headache, muscle aches, tiredness, and loss of appetite; followed by swelling of the salivary glands.
Testicular cancer symptoms include a painless lump or swelling in a testicle, testicle or scrotum pain, a dull ache in the abdomen, back, or groin, and a feeling of heaviness in the scrotum. Treatment for cancer of the testicles depends on the type of cancer (seminoma or nonseminoma), the stage of the cancer, and the patient's age and health.
Infertility is the diminished ability to conceive a child. The primary cause of infertility in men is a sperm disorder. In women, the primary cause of infertility is an ovulation disorder. Most forms of infertility can be treated. Conventional infertility therapies include drugs or surgery.
Hydrocele is a collection of clear fluid in a thin walled sack that also contains the testicle. Hydroceles are more common in males than females. There are two types of hydroceles: 1) communicating and 2)non-communicating. Hydroceles present at birth may resolve on their own. Hydroceles that appear in the teen or adult years may require surgery.
Sexual health information including birth control, impotence, herpes, sexually transmitted diseases, staying healthy, women's sexual health concerns, and men's sexual health concerns. Learn about the most common sexual conditions affecting men and women.
Men's health is an important component to a happy lifestyle and healthy relationships. Eating healthy, exercise, managing stress, and knowing when to have medical tests for a particular age is key to disease prevention in men.
Children's health is focused on the well-being of children from conception through adolescence. There are many aspects of children's health, including growth and development, illnesses, injuries, behavior, mental illness, family health and community health.
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