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Testicular Pain
Testicular pain, also known as scrotal pain, occurs when part or all of either one or both testicles hurt. Pain in the scrotum is also often included. Testicular pain may be of sudden onset or of long duration. Causes range from non serious muscular skeletal problems to emergency conditions such as Fournier gangrene and testicular torsion. The diagnostic approach involves making sure no serious conditions are present. Diagnosis may be supported by ultrasound, urine tests, and blood tests. Pain management is typically given with definitive management depending on the underlying cause. Definition Testicular pain is when part or all of either one or both testicles hurt. Pain of the scrotum is often included. It may be either acute, subacute or chronic depending on its duration. Chronic scrotal pain Chronic scrotal pain (pain for greater than 3 months) may occur due to a number of underlying conditions. It occurs in 15-19% of men post vasectomy, due to infections such as epididy ...
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Epididymis
The epididymis (; plural: epididymides or ) is a tube that connects a testicle to a vas deferens in the male reproductive system. It is a single, narrow, tightly-coiled tube in adult humans, in length. It serves as an interconnection between the multiple efferent ducts at the rear of a testicle (proximally), and the vas deferens (distally). Anatomy The epididymis is situated posterior and somewhat lateral to the testis. The epididymis is invested completely by the tunica vaginalis (which is continuous with the tunica vaginalis covering the testis). The epididymis can be divided into three main regions: * The head ( la, caput). The head of the epididymis receives spermatozoa via the efferent ducts of the mediastinium of the testis at the superior pole of the testis. The head is characterized histologically by a thick epithelium with long stereocilia (described below) and a little smooth muscle. It is involved in absorbing fluid to make the sperm more concentrated. The concentrat ...
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Emergency Medicine
Emergency medicine is the medical speciality concerned with the care of illnesses or injuries requiring immediate medical attention. Emergency physicians (often called “ER doctors” in the United States) continuously learn to care for unscheduled and undifferentiated patients of all ages. As first-line providers, in coordination with Emergency Medical Services, they are primarily responsible for initiating resuscitation and stabilization and performing the initial investigations and interventions necessary to diagnose and treat illnesses or injuries in the acute phase. Emergency physicians generally practise in hospital emergency departments, pre-hospital settings via emergency medical services, and intensive care units. Still, they may also work in primary care settings such as urgent care clinics. Sub-specializations of emergency medicine include; disaster medicine, medical toxicology, point-of-care ultrasonography, critical care medicine, emergency medical services, hy ...
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Epididymis
The epididymis (; plural: epididymides or ) is a tube that connects a testicle to a vas deferens in the male reproductive system. It is a single, narrow, tightly-coiled tube in adult humans, in length. It serves as an interconnection between the multiple efferent ducts at the rear of a testicle (proximally), and the vas deferens (distally). Anatomy The epididymis is situated posterior and somewhat lateral to the testis. The epididymis is invested completely by the tunica vaginalis (which is continuous with the tunica vaginalis covering the testis). The epididymis can be divided into three main regions: * The head ( la, caput). The head of the epididymis receives spermatozoa via the efferent ducts of the mediastinium of the testis at the superior pole of the testis. The head is characterized histologically by a thick epithelium with long stereocilia (described below) and a little smooth muscle. It is involved in absorbing fluid to make the sperm more concentrated. The concentrat ...
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Inflammation
Inflammation (from la, wikt:en:inflammatio#Latin, inflammatio) is part of the complex biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or Irritation, irritants, and is a protective response involving immune cells, blood vessels, and molecular mediators. The function of inflammation is to eliminate the initial cause of cell injury, clear out necrotic cells and tissues damaged from the original insult and the inflammatory process, and initiate tissue repair. The five cardinal signs are heat, pain, redness, swelling, and Functio laesa, loss of function (Latin ''calor'', ''dolor'', ''rubor'', ''tumor'', and ''functio laesa''). Inflammation is a generic response, and therefore it is considered as a mechanism of innate immune system, innate immunity, as compared to adaptive immune system, adaptive immunity, which is specific for each pathogen. Too little inflammation could lead to progressive tissue destruction by the harmful stimulus (e.g. b ...
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Necrosis
Necrosis () is a form of cell injury which results in the premature death of cells in living tissue by autolysis. Necrosis is caused by factors external to the cell or tissue, such as infection, or trauma which result in the unregulated digestion of cell components. In contrast, apoptosis is a naturally occurring programmed and targeted cause of cellular death. While apoptosis often provides beneficial effects to the organism, necrosis is almost always detrimental and can be fatal. Cellular death due to necrosis does not follow the apoptotic signal transduction pathway, but rather various receptors are activated and result in the loss of cell membrane integrity and an uncontrolled release of products of cell death into the extracellular space. This initiates in the surrounding tissue an inflammatory response, which attracts leukocytes and nearby phagocytes which eliminate the dead cells by phagocytosis. However, microbial damaging substances released by leukocytes would crea ...
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Cremasteric Reflex
The cremasteric reflex is a superficial (i.e., close to the skin's surface) reflex observed in human males. This reflex is elicited by lightly stroking or poking the superior and medial (inner) part of the thigh—regardless of the direction of stroke. The normal response is an immediate contraction of the cremaster muscle that pulls up the testis ipsilaterally (on the same side of the body). The reflex utilizes sensory and motor fibers from two different nerves. When the inner thigh is stroked, sensory fibers of the ilioinguinal nerve are stimulated. These activate the motor fibers of the genital branch of the genitofemoral nerve which causes the cremaster muscle to contract and elevate the testis. Clinical conditions In boys, this reflex may be exaggerated which can occasionally lead to a misdiagnosis of cryptorchidism. The cremasteric reflex may be absent with testicular torsion, upper and lower motor neuron disorders, as well as a spine injury of L1-L2. It can also occur if ...
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Testicular Torsion
Testicular torsion occurs when the spermatic cord (from which the testicle is suspended) twists, cutting off the blood supply to the testicle. The most common symptom in children is sudden, severe testicular pain. The testicle may be higher than usual in the scrotum and vomiting may occur. In newborns, pain is often absent and instead the scrotum may become discolored or the testicle may disappear from its usual place. Most of those affected have no obvious prior underlying health problems. Testicular tumor or prior trauma may increase risk. Other risk factors include a congenital malformation known as a "bell-clapper deformity" wherein the testis is inadequately attached to the scrotum allowing it to move more freely and thus potentially twist. Cold temperatures may also be a risk factor. The diagnosis should usually be made based on the presenting symptoms, but requires timely diagnosis and treatment to avoid testicular loss. An ultrasound can be useful when the diagnosis is unc ...
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Polyarteritis Nodosa
Polyarteritis nodosa (PAN) is a systemic necrotizing inflammation of blood vessels (vasculitis) affecting medium-sized muscular arteries, typically involving the arteries of the kidneys and other internal organs but generally sparing the lungs' circulation. Small aneurysms are strung like the beads of a rosary, therefore making this "rosary sign" an important diagnostic feature of the vasculitis. PAN is sometimes associated with infection by the hepatitis B or hepatitis C virus. The condition may be present in infants. PAN is a rare disease. With treatment, five-year survival is 80%; without treatment, five-year survival is 13%. Death is often a consequence of kidney failure, myocardial infarction, or stroke. Signs and symptoms PAN may affect nearly every organ system and thus can present with a broad array of signs and symptoms. These manifestations result from ischemic damage to affected organs, often the skin, heart, kidneys, and nervous system. Constitutional symptoms are see ...
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Hydrocele
A hydrocele is an accumulation of serous fluid in a body cavity. A hydrocele testis, the most common form of hydrocele, is the accumulation of fluids around a testicle. It is often caused by fluid collecting within a layer wrapped around the testicle, called the tunica vaginalis, which is derived from peritoneum. Provided there is no hernia present, it goes away without treatment in the first year. Although hydroceles usually develop in males, rare instances have been described in females in the Canal of Nuck. Primary hydroceles may develop in adulthood, particularly in the elderly and in hot countries, by slow accumulation of serous fluid. This is presumably caused by impaired reabsorption, which appears to be the explanation for most primary hydroceles, although the reason remains obscure. A hydrocele can also be the result of a plugged inguinal lymphatic system caused by repeated, chronic infection of ''Wuchereria bancrofti'' or ''Brugia malayi'', two mosquito-borne parasites o ...
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Orchitis
Orchitis is inflammation of the testes. It can also involve swelling, pains and frequent infection, particularly of the epididymis, as in epididymitis. The term is from the Ancient Greek ὄρχις meaning "testicle"; same root as ''orchid''. Signs and symptoms Symptoms of orchitis are similar to those of testicular torsion. These can include: * hematospermia (blood in the semen) * hematuria (blood in the urine) * severe pain * visible swelling of a testicle or testicles and often the inguinal lymph nodes on the affected side. Causes Orchitis can be related to epididymitis infection that has spread to the testicles (then called "epididymo-orchitis"), sometimes caused by the sexually transmitted diseases chlamydia and gonorrhea. It has also been reported in cases of males infected with brucellosis. Orchitis can also be seen during active mumps, particularly in adolescent boys. Ischemic orchitis may result from damage to the blood vessels of the spermatic cord during inguinal h ...
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Prostatitis
Prostatitis is an umbrella term for a variety of medical conditions that incorporate bacterial and non-bacterial origin illnesses in the pelvic region. In contrast with the plain meaning of the word (which means "inflammation of the prostate"), the diagnosis may not always include inflammation. Prostatitis is classified into acute, chronic, asymptomatic inflammatory prostatitis, and chronic pelvic pain syndrome. In the United States, prostatitis is diagnosed in 8% of all male urologist visits and 1% of all primary care physician visits for male genitourinary symptoms. Classification The term ''prostatitis'' refers to inflammation of the tissue of the prostate gland. It may occur as an appropriate physiological response to an infection, or it may occur in the absence of infection. In 1999, the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) devised a new classification system. For more specifics about each type of prostatitis, including information on symp ...
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Epididymitis
Epididymitis is a medical condition characterized by inflammation of the epididymis, a curved structure at the back of the testicle. Onset of pain is typically over a day or two. The pain may improve with raising the testicle. Other symptoms may include swelling of the testicle, burning with urination, or frequent urination. Inflammation of the testicle is commonly also present. In those who are young and sexually active gonorrhea and chlamydia are frequently the underlying cause. In older males and men who practice insertive anal sex, enteric bacteria are a common cause. Diagnosis is typically based on symptoms. Conditions that may result in similar symptoms include testicular torsion, inguinal hernia, and testicular cancer. Ultrasound can be useful if the diagnosis is unclear. Treatment may include pain medications, NSAIDs, and elevation. Recommended antibiotics in those who are young and sexually active are ceftriaxone and doxycycline. Among those who are older, ofloxacin ...
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