Scrotal Pain & Swelling
Assumptions
The student knows the anatomy of the scrotal contents. The student is familiar with the embryologic
development and descent of the testicle.
Objectives
1. Generate a list of potential diagnoses for the patient who presents with pain or a mass in the scrotum.
 Discuss testicular vs. extratesticular origins
 Discuss benign vs. malignant causes
 Discuss emergent vs. nonemergent causes
2. List history and physical exam findings that will help you differentiate etiologies. Be sure to discuss the
following issues:
 pain - presence, absence, onset, severity
 palpation - distinguish testicular from extratesticular (adnexal) mass
 effect of Valsalva maneuver
 transillumination
3. Discuss the diagnostic algorithm for scrotal swelling and/or pain.
4. Discuss the staging and treatment of testicular cancer.
5. Discuss treatment of non-malignant causes of scrotal swelling and/or pain.
6. Discuss diagnosis and treatment of the undescended testicle (be sure to consider age of diagnosis).
Problem
1. A 35-year-old man presents with a new mass in his left hemiscrotum.
 What findings on history and physical exam would help you to determine if this is a mass in the
testicle?
 What lab tests would you order if there is a mass in the testicle?
 If you think the mass is malignant what diagnostic and therapeutic intervention would you
recommend to the patient?
2. A 15-year-old boy presents with severe pain in his scrotum.
 Discuss how the history and physical exam might help you to differentiate between torsion and
epididymitis.
Prevention
1. Discuss role of scrotal self-exam in early detection of testicular cancer.
2. Discuss methods for prevention/early detection of testicular cancer for patients with a previously
undescended testicle.