Swollen and/or Painful Scrotum

Abstract

Medical conditions affecting the scrotum may present themselves with pain without any sign of swelling, with a painful swelling, or with a painless swollen scrotum. A sudden onset of a scrotal pain or swelling is defined as “acute ­scrotum” and can have a variety of causes. The diagnostic process is essential to rule out conditions that prompt urgent hospital referral. Among the causes of a painful and swollen scrotum, testicular torsion is the most feared one, as the likelihood of testicular salvage decreases as ischemia increases. Several conditions can mimic testicular torsion, such as torsion of testicular appendages, epididymitis, epididymo-orchitis, trauma, varicocele, inguinal hernia, and even systemic disease, like the rare Schonlein-Henoch purpura. Besides, several conditions can cause painless scrotal swelling. Among these, a testicular cancer must always be suspected when a firm mass is discovered within the testicular parenchyma. The aim of this chapter is to provide a practical flowchart to assist the physician in decision making among the most important scrotal diseases, guiding the choice between an urgent hospital referral and conservative management.