Testicular pain, what are its causes?

| Testicular pain requires an immediate medical evaluation, since, in many cases, early medical intervention avoids future sequelae, such as the loss of the testicle (or test).

• The most common causes of testicular pain are epididymo-orchitis, testicular torsion, and hydatid torsion of Morgagni.
• Testicular torsion is the most serious and has to be treated surgically in the first five hours of pain to avoid necrosis.
• The existence of a single healthy testicle ensures adequate reproductive capacity.

The causes and their treatments

The three most common causes of testicular pain in children and adolescents are:

• Epididymo-orchitis

It is an infection located in the testicle and in the epididymis (coiled duct located inside the testicle). It manifests with severe pain, local inflammation, and redness of the scrotal skin. There may be discomfort when urinating. Treatment consists of administering antibiotics and their cure is complete, without sequelae.

It is the most serious situation. It is more common in newborns and adolescents. Early diagnosis and immediate medical attention are essential to avoid the loss of the testicle. It consists of the twisting or twisting of the testicle on the spermatic cord. Torsion compromises the blood supply to the testicle, so that, if it is not surgically corrected in the first 4-6 hours of pain, irreversible necrosis of the testicle can occur. Doppler ultrasound is key to its diagnosis, as it can measure the flow of arterial blood to the testicle.

Treatment is surgical to correctly position the twisted testicle and fix it to prevent future twisting. In the case of complete and irreversible necrosis, total removal of the testicle must be performed, since immunological alterations occur that can lead to lesions in the contralateral testicle that compromise its fertile capacity; In addition, the healthy testicle must be fixed to prevent torsion.

In cases of torsion of the testicle and orchiectomy (removal of the testicle), there is the possibility of placing a testicular prosthesis to take the place of the removed testicle in order to reduce the psychological repercussions of the amputation. The existence of a single healthy teste ensures an adequate reproductive capacity.

• Morgagni Hydatid Twist

This structure is an embryonic remnant that lacks function after birth and that remains attached to the testicle by a fine pedicle in which its vessels are located and that can easily be rotated, compromising its blood supply and causing intense pain. On examination, it is sometimes possible to appreciate a mobile bluish spot inside the scrotum that is painful on palpation. Testicular pain decreases with elevation of the teste. Treatment is based on anti-inflammatories and rest. The diagnosis should be confirmed by Doppler ultrasound of the affected testicle to rule out testicular torsion.