Testicular Disorders (cont.)
Steven Doerr, MD
Steven Doerr, MD
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.
William C. Shiel Jr., MD, FACP, FACR
William C. Shiel Jr., MD, FACP, FACR
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 this Article
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 treatment
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 as approximately 40% of males will have the bbell clapper abnormality on both sides.
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 cases of testicular torsion can occur and then resolve spontaneously, and the health care professional 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% and 10%.
The treatment of uncomplicated epididymitis can generally be managed as an outpatient, and consists of the following treatment measures:
In general, acute epididymitis that is properly treated resolves without complications. However, in some cases of epididymitis, such as those associated with serious systemic symptoms or in those accompanied by various complications, hospitalization may be necessary. A urologist will be consulted in these more serious cases.
Torsion of a testicular appendage treatment
The treatment for torsion of the testicular or epididymal appendage is directed toward relief of symptoms, and consists of the following measures:
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.
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:
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 blood collections (hematoceles), penetrating trauma, and certain cases of testicular dislocation.
Inguinal hernia treatment
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).
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:
Bacterial orchitis and epididymo-orchitis require antibiotics. Those cases caused by viruses do not require antibiotics.
Kidney stone treatment
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:
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 treatment
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.
Reviewed by William C. Shiel Jr., MD, FACP, FACR on 6/6/2012