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According to Prehn's sign, the physical lifting of the testicles relieves the pain of epididymitis but not pain caused by testicular torsion. [4] Negative Prehn's sign indicates no pain relief with lifting the affected testicle, which points towards testicular torsion which is a surgical emergency and must be relieved within 6 hours.
Given the treatment implications of testicular torsion, it is important to distinguish testicular torsion from other causes of testicular pain, such as epididymitis, which can present similarly. While both conditions can cause testicular pain, the pain of epididymitis is typically localized to the epididymis at the rear pole of the testicle.
Untreated, acute epididymitis's major complications are abscess formation and testicular infarction. Chronic epididymitis can lead to permanent damage or even destruction of the epididymis and testicle (resulting in infertility and/or hypogonadism), and infection may spread to any other organ or system of the body. Chronic pain is also an ...
Testicular torsion can happen in a number of ways. It can occur when you're working out, having sex, or even sleeping. It's most common between the ages of 12 and 18, but can happen at any age.
The differential diagnosis of testicular pain is broad and involves conditions from benign to life-threatening. The most common causes of pain in children presenting to the emergency room are testicular torsion (16%), torsion of a testicular appendage (46%), and epididymitis (35%). [4] In adults, the most common cause is epididymitis. [citation ...
Therefore, testicular torsion is a surgical emergency and the role of ultrasound is to differentiate it from epididymitis as both disease presents with acute testicular pain clinically. [citation needed] There are two types of testicular torsion: extravaginal and intravaginal. Extravaginal torsion occurs exclusively in newborns.
The cremasteric reflex can be helpful in recognizing testicular emergencies. The presence of the cremasteric reflex does not eliminate testicular torsion from a differential diagnosis, but it does broaden the possibilities to include epididymitis or other causes of scrotal and testicular pain .
Epididymitis is the inflammation (swelling) of the tube connecting testicle and vas deferens. [16] When the testis becomes swollen, in addition to the epididymis, this is called epididymo-orchitis. Epididymitis can be acute (lasting less than six weeks) or chronic (lasting equal to or more than six weeks). [17]