Assessment

HISTORY. Establish a history of sudden scrotal pain, redness, swelling, and extreme scrotal and groin tenderness. Determine if the patient has experienced fever, chills, or malaise. Ask the patient if he has experienced nausea and vomiting. Elicit a history of prostatitis, urethritis, or chronic urinary infections. Ask the patient if he has been diagnosed with tuberculosis. Determine if the patient has undergone a prostatectomy or has had a traumatic injury to the genitalia. Take a sexual history to determine if the patient has had unprotected sex with a partner who may have had an STI.

PHYSICAL EXAMINATION. Inspect the patient's scrotum, noting any marked edema or redness. Gently palpate the scrotum for tenderness or pain. Observe any urethral discharge. Observe the patient's gait; patients with epididymitis often assume a characteristic waddle to protect the groin and scrotum.

PSYCHOSOCIAL. The patient may be concerned about his sexuality. He may be fearful of becoming sterile or impotent and anxious about whether he can continue to have sexual relationships. The patient may express anger or feelings of victimization if the condition was caused by an STI.

Diagnostic Highlights

General Comments: Diagnosis is made based on visual symptoms and isolation of infective organsims.

Test

Normal Result

Abnormality with Condition

Urine culture and sensitivity tests

Cultures for sexually transmitted infections (STIs)

<10,000 bacteria/mL

Negative culture N/A

Pyuria; white blood cell count >10,000 mm3

>10,000 bacteria/mL; pathogen is identified

Positive for STI

Pain is relieved when the scrotum is lifted onto the symphysis

A urinary tract infection can contribute to epididymitis

A urinary tract infection can contribute to epididymitis

An STI can lead to epididymitis

Testicular torsion may be present if pain is not relieved when the scrotum is lifted onto the symphysis

Other Tests: An ultrasound is done to rule out testicular torsion, which presents with similar symptoms, and is a medical emergency.

0 0

Post a comment