Page 147 - PJ MED OPS Handbook 8th Ed

Testicular Pain

SPECIAL CONSIDERATIONS:
1. The primary concern in testicular pain is differentiating testicular torsion from other
causes of testicular pain.
2. Testicular torsion is an medical emergency requiring urgent correction to prevent loss of
the affected testicle.
3. Other common causes of testicular pain include epididymitis and orchitis, infections com-
monly caused by STIs, as well as hernias and testicular masses.

Signs and Symptoms:
1. Testicular Torsion:
a. Sudden onset testicular pain
b. Usually associated with activity
c. Associated testicular swelling
d. Abnormal position of the affected testicle
e. Absent cremasteric reflex
f. Symptoms not relieved by testicular elevation
g. Usually associated with pain induced nausea and vomiting
2. Epididymitis:
a. Gradual onset of worsening pain
b. May have fever and/or dysuria
c. Can also be traumatic
d. Symptoms may be relieved with elevation
e. Significant swelling may be present

Management:
1. If pain is sudden onset and the testicle is lying abnormally in the scrotum, an attempt to manu-
ally turn the testicle is warranted.
a. A single attempt to rotate the testicle outward (like opening the pages of a book) should be
made.
i) With torsion of the left testis, hold the testicle with the right thumb and forefinger and
then rotate the testicle clockwise 180°. This manipulation may need to be repeated 2–3
times, because testicular torsion may involve rotations of 180°–720°. These repeated at-
tempts should be guided by resolution of pain and return to normal anatomy.
ii) For torsion of the right testicle, the procedure is similar except that the testicle is held us-
ing the left thumb and forefinger and the testicle is rotated in a counterclockwise direction.
b. If pain increases, 1 attempt to rotate the opposite direction should be made.
c. Successful correction will result in relief of pain.
2. Suspect Urinary Tract Infection if:
a. Gradual onset of pain with a normal lying testicle
b. Dysuria-painful urination
c. Urinary urgency and frequency
d. Cloudy, malodorous, or dark urine may be present

Chapter 8. Tactical Medical Emergency Protocols (TMEPs) n 145