The acute, nontraumatic scrotum: assessment, diagnosis, and management

This article reviews the acute, nontraumatic scrotal conditions of testicular torsion, torsion of an epididymal or testicular appendage, and epididymitis in order to assist the nurse practitioner (NP) with arriving at a diagnosis. Primary and emergency care management are presented.

Selected published literature in refereed journals and the authors' clinical experiences.

Signs and symptoms of testicular pathologies can overlap, making diagnosis problematic. However, key features can raise the NP's index of suspicion for a particular diagnosis and can assist in selecting the most appropriate management strategy.

Although these conditions are rarely fatal, they may carry a risk of morbidity in the form of testicular necrosis, infarction, or atrophy with concomitant infertility. Any patient with scrotal or testicular pain should be presumed to have testicular torsion until proven otherwise, as this condition carries a high degree of morbidity. The information gained through a thorough history and physical examination can assist in arriving at the proper diagnosis.