Trauma Testicular trauma may cause torsion, testicular rupture or haematoma which should be referred to a urologist or surgeon for a specialist opinion and possible intervention.
Inguinal Hernias May have a history of fluctuant testicular swelling. These have the potential to become irreducible and incarcerated causing pain and discomfort.
Fournier’s Gangrene This is necrotising fasciitis of the perineum and is a urological emergency. It is more common in diabetes and vasculopaths. Presents with severe pain and rapidly spreading necrotic cellulitis.
Malignancy Testicular cancers typically present in men aged 15-40 years with a small hard lump within the testis with/without pain. If any concern an USS may be indicated.
Oedema Peripheral oedema may progress up the legs to the testes causing diffuse swelling and pain; this will require diuretics and medical management.
Cysts/Hydroceles Cyst and hydroceles should be relatively painless, but may cause a heavy or dragging sensation.
Referred Pain e.g. Renal Colic, AAA, Appendicitis Abdominal pain may be referred into the groin and testes. It is important to complete a thorough abdominal examination and consider these differentials, particularly in older patients.
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