2025 – PAGE 75 – ADOLESCENT MEDICINE

TESTICULAR TORSION

With testicular torsion, there is an absence of the CREMASTERIC REFLEX. Stroking the inner thigh normally elicits scrotal elevation. If that reflex is absent, then it is highly suggestive of testicular torsion. Another symptom is increased pain when the scrotum is elevated.

TORSION OF THE APPENDIX TESTES OR EPIDIDYMIS

Torsion of the appendix testes, or of the epididymis, is painful but benign. Look for the Blue Dot sign (more commonly seen with torsion of the appendix testes than the appendix epididymis). Treat with NSAIDS.

MNEMONIC: Do you remember the BLUE-DOT SPECIALS at KMART®? Imagine a huge blue-dot special on a big bottle of ibuprofen! This should remind you of the very benign treatment.

EPIDIDYMITIS

Epididymitis is usually caused by an STD and can present with DYSURIA, frequency, fever, pain at the epididymis, and possibly urethral discharge. Pain is typically unilateral. Etiologies include CHLAMYDIA, GONORRHEA, and E. COLI (especially if there’s a history of anal sex).

ORCHITIS

Orchitis is also known as testicular inflammation and is usually caused by a virus. Look for unilateral pain and possibly a fever. There is NO discharge and NO dysuria. Etiologies include MUMPS, and it can also be secondary to epididymitis. If testicular atrophy is present, there is an increased risk of CANCER. If both sides are involved, there is an increased risk of infertility!

BALANITIS

Balanitis is an inflammation/infection of the glans. It is associated with phimosis if it occurs before the age of 3.

PHIMOSIS

Phimosis is defined as a tight foreskin that prevents retraction over the glans and persists beyond age 3. For most boys, foreskin is fully retractable by 3 years of age. Initial treatment is usually with topical steroids.

IMAGE: www.pbrlinks.com/PHIMOSIS1

PENILE EPIDERMAL INCLUSION CYSTS

Penile epidermal inclusion cysts are small, white, benign bumps located on the glans. They are often referred to as “pearly penile papules.”