The role of clinical examination in the differential diagnosis of acute testicular pain
Date First Published:
June 27, 2006
Last Updated:
July 19, 2006
Report by:
Miss Olajumoke Adeloye, Medical Student (Manchester Royal Infirmary)
Search checked by:
Miss Olajumoke Adeloye, Manchester Royal Infirmary
Three-Part Question:
In [male patients presenting with acute testicular pain] is [clinical examination enough] to [differentiate torsion, rupture and epididymo-orchitis]
Clinical Scenario:
A 20 year old gentleman presents to the Emergency department with a one hour history of an acute onset of severe testicular pain. On examintion the left testicle was found to be rather swollen and tender.
Search Strategy:
Ovid MEDLINE 1966 to June Week 4 2006
EMBASE 1980 to 2006 Week 27
PUBMED
CINAHL - Cumulative Index to Nursing & Allied Health Literature 1982 to June Week 5 2006
The Cochrane Library
EMBASE 1980 to 2006 Week 27
PUBMED
CINAHL - Cumulative Index to Nursing & Allied Health Literature 1982 to June Week 5 2006
The Cochrane Library
Search Details:
[exp Physical Examination/ or clinical examination.mp. or exp Clinical Competence/
] AND [exp Testicular Diseases/pa, di, pp, pc, th [Pathology, Diagnosis, Physiopathology, Prevention & Control, Therapy]] OR [exp Physical Examination/ or clinical examination.mp. or exp Clinical Competence/] AND [testicular torsion.mp. or exp Spermatic Cord Torsion/] OR [exp Physical Examination/ or clinical examination.mp. or exp Clinical Competence/] AND [*Rupture/ or *Testis/ or testicular rupture.mp.] OR [exp Physical Examination/ or clinical examination.mp. or exp Clinical Competence/] AND [Spermatic Cord Torsion/ or Epididymis/ or Epididymitis/ or Orchitis/ or epididymo-orchitis.mp. or Testis/] AND [limit 11 to (humans and english language and "all adult (19 plus years)")]
] AND [exp Testicular Diseases/pa, di, pp, pc, th [Pathology, Diagnosis, Physiopathology, Prevention & Control, Therapy]] OR [exp Physical Examination/ or clinical examination.mp. or exp Clinical Competence/] AND [testicular torsion.mp. or exp Spermatic Cord Torsion/] OR [exp Physical Examination/ or clinical examination.mp. or exp Clinical Competence/] AND [*Rupture/ or *Testis/ or testicular rupture.mp.] OR [exp Physical Examination/ or clinical examination.mp. or exp Clinical Competence/] AND [Spermatic Cord Torsion/ or Epididymis/ or Epididymitis/ or Orchitis/ or epididymo-orchitis.mp. or Testis/] AND [limit 11 to (humans and english language and "all adult (19 plus years)")]
Outcome:
MEDLINE 468
EMBASE 316
CINAHL 50
PUBMED 211
The Cochrane Library Issue 2 2006
testicular torsion, ti.ab.kw OR spermatic cord torsion -[MeSH] 3 articles none relevant
EMBASE 316
CINAHL 50
PUBMED 211
The Cochrane Library Issue 2 2006
testicular torsion, ti.ab.kw OR spermatic cord torsion -[MeSH] 3 articles none relevant
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| The acute scrotum: a review of 40 cases. Abul, Fawzi. Al-Sayer, Hilal. Arun, Narayanaswamy. May-June 2005 Kuwait | 40 patients hospitalised January 2002 and December 2002 with acute scrotal pain. | Retrospective cohort study | They were studied with respect to history, physical examination, blood tests, urine analysis including culture, and scrotal ultrasonography with color Doppler study. | Epididymitis was found to be the commonest cause of the acute scrotum, followed by testicular torsion. Patients with testicular torsion presented earlier than those with Epididymitis (19.1 h vs 4.5 days). The testis was salvaged in 81.8% of patients with testicular torsion. The accuracy of ultrasonography was only 72.7% in testicular torsion. | The actual sample size used was quite small which would have introduced some bias. There was no statement that they gained ethical approval for the study they carried out. |
Author Commentary:
There is limited evidence available but it is a topic that is side-lined in many studies. However, its importance in the managment of the acute scrotum, is still paramount.
Bottom Line:
Clinical examination is an extremely important adjunct to other tests and investigations in the management of the testicular pain.
References:
- Abul, Fawzi. Al-Sayer, Hilal. Arun, Narayanaswamy.. The acute scrotum: a review of 40 cases.