Even if you currently are not treating male patients in your pelvic rehabilitation program, continue to read for critical information about testicular pathology. Any male patient (or family member, friend, or loved one) can present with a sudden onset of symptoms that require medical follow-up. Testicular pathology, as pointed out in this article from Medscape, can be benign or life-threatening. (If you are not able to view the article, you can first create a free user account for Medscape and then view the information. Medscape is also a great resource as they will send you weekly article reviews on various medical topics.) The article has images of testicular pathology throughout the presentation which can help in understanding the anatomy and pathology present. Following are a few diagnoses that are highlighted in the article, and that may mimic clinical symptoms of thoracolumbar radiculopathy or pelvic pain.
Testicular torsion: Commonly occurring in adolescent males, torsion happens when the testicle twists, impairing the blood flow to and from the testicle. If the twisting last 4-6 hours or longer, the testicle can become necrotic and no longer be viable. Pain, swelling, and erythema are common in this condition, and any patient who presents with acute onset of scrotal pain must be examined for this condition.
Testicular fracture: Blunt trauma can cause significant injury to the testicles, and conservative management may be all that is required. The testicle itself can fracture, or be degloved, and a significant hematoma can occur. Surgical intervention may be required for preservation of the testicle.
Hydrocele: Fluid can collect either in the scrotum or in the spermatic cord (the "tube" that extends from the lower abdominal wall to the scrotum, carrying neurovascular and other structures). A painless lump may be the first sign of this condition. Aspiration or surgical resection may be required.
Varicocele: An enlargement of the veins within the scrotum can lead to a varicocele. While this may not cause dysfunction for the patient, a varicocele can lead to infertility and possibly discomfort due to the dragging sensation and increased pressure from enlargement.
Epididymitis: Testicular swelling, redness, and tenderness may be caused by an infection to the epididymis, a structure within the scrotum. A patient who presents with these symptoms may also have a fever and should be evaluated medically.
In addition to the above diagnoses, a testicular tumor might be first noted as a firm, painless nodule in either testicle. According to the Medscape article, a testicular tumor is the most common solid tumor found in men ages 20-35. Men need reminders just as women do for completing testicular self-exams and reporting any concerns to the physician. Here is a link to information on testicular self-exams, in case you find it helpful for patient education purposes. Keep the above information in mind when a patient presents with a change in symptoms or sudden, severe pain in the testicles.