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.
Laboratory testing may include:
- blood work
- urinalysis
- 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.
