陰嚢痛、陰嚢部痛

WordNet

cause emotional anguish or make miserable; "It pains me to see my children not being taught well in school" (同)anguish, hurt
a symptom of some physical hurt or disorder; "the patient developed severe pain and distension" (同)hurting
a bothersome annoying person; "that kid is a terrible pain" (同)pain in the neck, nuisance
a somatic sensation of acute discomfort; "as the intensity increased the sensation changed from tickle to pain" (同)pain_sensation, painful sensation
emotional distress; a fundamental feeling that people try to avoid; "the pain of loneliness" (同)painfulness
relating to or having or lying within a scrotum; "scrotal mammals"; "scrotal testes"

PrepTutorEJDIC

〈C〉〈U〉(肉体のある部分の)『苦痛』,『痛み』 / 〈U〉(精神的な)『苦痛』,心痛 / 《複数形で》骨折り,苦労,努力 / 〈C〉不快感,いやな感じ;うんざりさせるもの,やっかい者 / (肉体的・精神的に)…‘に'苦痛を与える(受動態にできない)
《補語にのみ用いて》腹を立てて / 《補語にのみ用いて》(心が)鐘ついて / 不愉快な,気まずい
とうちゃん(papa)

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/12/04 12:09:25」(JST)

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Testicular or scrotal pain occurs when part or all of either one or both testicles hurt. Pain in the scrotum is also often included. Testicular pain may be either acute, subacute or chronic depending on its duration. Causes rank from benign muscular skeletal problems to emergency conditions such as Fournier's gangrene and testicular torsion. Pain management is typically given with definitive management depending on the underlying cause. The diagnostic approach involves making sure no serious conditions are present and may involve the use of ultrasound imaging and laboratory evaluations.

Definition

Testicular pain is when part or all of either one or both testicles hurt. Pain of the scrotum is often included. It may be either acute, subacute or chronic depending on its duration.

Chronic scrotal pain

Chronic scrotal pain (pain for greater than 3 months) may occur due to a number of underlying conditions.^[1] It occurs in 15-19% of people post vasectomy, due to infections such as epididymitis, prostatitis, and orchitis, as well as varicocele, hydrocele, spermatocele, polyarteritis nodosa, testicular torsion, previous surgery and trauma.^[1] In 25% of cases the cause is never determined.^[1] The pain can persist for a long and indefinite period of time following the vasectomy, in which case it is termed post-vasectomy pain syndrome (PVPS).

Differential diagnosis

The differential diagnosis of testicular pain is broad and involves conditions from benign to life threatening. The most common causes of pain in children presenting to the emergency room are testicular torsion (16%), torsion of a testicular appendage (46%), and epididymitis (35%).^[2] In adults the most common cause is epididymitis.

Testicular torsion

Testicular torsion usually presents with an acute onset of diffuse testicular pain and tenderness of less than 6 hrs of duration. There is often an absent or decreased cremasteric reflex, the testicle is elevated, and often is horizontal.^[3] It occurs annually in about 1 in 4000 males before 25 years of age,^[1] is most frequent among adolescents ( 65% of cases presenting between 12 – 18 years of age ),^[4] and is rare after 35 years of age.^[5] Because it can lead to necrosis within a few hours, it is considered a surgical emergency.^[5] Another version of this condition is a chronic illness called intermittent testicular torsion (ITT) which is characterized by recurrent rapid acute onset of pain in one testis which will temporarily assume a horizontal or elevated position in the scrotum similar to that of a full torsion followed by eventual spontaneous detortion and rapid solution of pain. Nausea or vomiting may also occur.^[6]

Epididymitis

Epididymitis occurs when there is inflammation of the epididymis (a curved structure at the back of the testicle).^[5] This condition usually presents with gradual onset of varying degrees of pain, and the scrotum may be red, warm and swollen. It is often accompanied by symptoms of a urinary tract infection, fever, and in over half of cases it presents in combination with orchitis.^[5] In those between the ages of 14 to 35 it is usually caused by either gonorrhea or chlamydia. In people either older or younger E. coli is the most common bacterial infection.^[5] Treatment involves the use of antibiotics.^[5]

Fournier's gangrene

Fournier's gangrene ( an aggressive and rapidly spreading infection of the perineum ) usually presents with fever and intense pain. It is a rare condition but fatal if not identified and aggressively treated with a combination of surgical debridement and broad spectrum antibiotics.^[7]

Others

Segmental testis infarction in a patient presenting with right testis pain.

Many other less common conditions can lead to testicular pain. These include inguinal hernias, injury, hydroceles, and varicoceles among others. Testicular cancer is usually painless.^[8] Another potential cause is blue balls.^[9]

Diagnostic approach

Physical findings

The cremaster reflex (elevation of the testicle in response to stroking the upper inner thigh) is typically present in epididymitis but absent in testicular torsion as the testis is already elevated.^[5] Prehn's sign ( the relief of pain with elevation ) though a classic physical exam finding has not been found to be reliable in distinguishing torsion from other causes of testicular pain such as epididymitis.^[10]

Laboratory tests

Useful tests that may help in the determination of the cause include a urinalysis (usually normal in testicular torsion). Pyuria and bacteriuria (white blood cells and bacteria in the urine) in patients with acute scrotum suggests an infectious cause such as epididymitis or orchitis and specific testing for gonorrhea and chlamydia should be done.^[5] All people with chronic pain should be tested for gonorrhea and chlamydia.^[1]

Imaging

Ultrasound is useful if the cause is not certain based on the above measures.^[11] If the diagnosis of torsion is certain, imaging should not delay definitive management such as physical maneuvers and surgery.^[5]

References

^ ^a ^b ^c ^d ^e Wampler SM, Llanes M; Llanes (September 2010). "Common scrotal and testicular problems". Prim. Care 37 (3): 613–26, x. doi:10.1016/j.pop.2010.04.009. PMID 20705202.
^ Lewis AG, Bukowski TP, Jarvis PD, Wacksman J, Sheldon CA; Bukowski; Jarvis; Wacksman; Sheldon (February 1995). "Evaluation of acute scrotum in the emergency department". J. Pediatr. Surg. 30 (2): 277–81; discussion 281–2. doi:10.1016/0022-3468(95)90574-X. PMID 7738751.
^ Karmazyn B, Steinberg R, Kornreich L et al. (March 2005). "Clinical and sonographic criteria of acute scrotum in children: a retrospective study of 172 boys". Pediatr Radiol 35 (3): 302–10. doi:10.1007/s00247-004-1347-9. PMID 15503003.
^ Edelsberg JS, Surh YS; Surh (August 1988). "The acute scrotum". Emerg. Med. Clin. North Am. 6 (3): 521–46. PMID 3292226.
^ ^a ^b ^c ^d ^e ^f ^g ^h ⁱ Trojian TH, Lishnak TS, Heiman D; Lishnak; Heiman (April 2009). "Epididymitis and orchitis: an overview". Am Fam Physician 79 (7): 583–7. PMID 19378875.
^ Uribe, Juan F. (2008). Potts, Jeannette M., ed. Genitourinary pain and inflammation: diagnosis and management. Totowa, New Jersey: Humana. p. 150. ISBN 978-1-58829-816-4. Missing |last1= in Editors list (help)
^ Burch DM, Barreiro TJ, Vanek VW; Barreiro; Vanek (November 2007). "Fournier's gangrene: be alert for this medical emergency". JAAPA 20 (11): 44–7. doi:10.1097/01720610-200711000-00020. PMID 18035764.
^ "Testicle pain: MedlinePlus Medical Encyclopedia". National Institute of Health.
^ Chalett JM, Nerenberg LT; Nerenberg (October 2000). ""Blue balls": A diagnostic consideration in testiculoscrotal pain in young adults: A case report and discussion". Pediatrics 106 (4): 843. doi:10.1542/peds.106.4.843. PMID 11015532.
^ Lavallee ME, Cash J; Cash (April 2005). "Testicular torsion: evaluation and management". Curr Sports Med Rep 4 (2): 102–4. doi:10.1097/01.CSMR.0000306081.13064.a2. PMID 15763047.
^ Galejs LE (February 1999). "Diagnosis and treatment of the acute scrotum". American Family Physician 59 (4): 817–24. PMID 10068706.

UpToDate Contents

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1. 成人における急性陰嚢症の評価 evaluation of the acute scrotum in adults
2. 小児および思春期における陰嚢痛の原因 causes of scrotal pain in children and adolescents
3. 小児および思春期における陰嚢痛または腫脹の評価 evaluation of scrotal pain or swelling in children and adolescents
4. 成人男性における非急性陰嚢疾患の評価 evaluation of nonacute scrotal pathology in adult men
5. 小児および思春期における無痛性陰嚢腫脹の原因 causes of painless scrotal swelling in children and adolescents

English Journal

Percutaneous MR-guided cryoablation of prostate cancer: initial experience.

Gangi A, Tsoumakidou G, Abdelli O, Buy X, de Mathelin M, Jacqmin D, Lang H.SourceDepartment of Interventional Radiology, University Hospital of Strasbourg, 1 Place de l'Hôpital, 67091, Strasbourg, France, gangi@unistra.fr.
European radiology.Eur Radiol.2012 Aug;22(8):1829-35. Epub 2012 Mar 27.
OBJECTIVE: We report our initial experience and the technical feasibility of transperineal prostate cryoablation under MR guidance.METHODS: Percutaneous MR-guided cryoablation was performed in 11 patients with prostatic adenocarcinoma contraindicated for surgery (mean age: 72 years, mean Gleason sc
PMID 22752525

Pediatric surgery triage: Problems and improvements.

Ukiyama E, Nirasawa Y, Watanabe Y, Makino A, Masuko K, Mochizuki T, Ito Y.SourceDepartment of Pediatric Surgery, Kyorin University Faculty of Medicine, Tokyo Department of Pediatric Surgery, International University of Health and Welfare, Atami Hospital, Shizuoka, Japan.
Pediatrics international : official journal of the Japan Pediatric Society.Pediatr Int.2012 Aug;54(4):501-3. doi: 10.1111/j.1442-200X.2012.03669.x.
Background: The Canadian Paediatric Triage and Acuity Scale (P-CTAS) is used and modified at hospitals as a triage tool for pediatric patients before they are seen in emergency rooms. Pediatric surgery patients account for very few of the many patients in emergency departments, but they should be
PMID 22621411

Japanese Journal

急性陰嚢症を契機に発見された精巣腫瘍の1例

星山文明,百瀬均,喜馬啓介,藤本健,小野隆征,大山信雄
泌尿器科紀要 = Acta urologica Japonica 60(8), 401-403, 2014-08
… A37-year-old man visited our hospital with a chief complaint of sudden onset of right scrotal pain. …
NAID 120005468363

自己去勢を企図した性同一性障害の1例

甲斐文丈,本山大輔,海野智之,須床洋
日本泌尿器科學會雑誌 105(1), 26-28, 2014
症例は29歳，男性．性同一性障害患者．主訴は陰嚢部痛．自己去勢を試みたが，出血と疼痛のため中止し，2時間後に当院に受診した．両側精巣は摘除されておらず，腰椎麻酔下に陰嚢縫合術を施行した．術後，自傷の反復は認めない．
NAID 130004922379

鼠径ヘルニアを介した炎症波及により陰嚢膿瘍を合併した虫垂炎の1例

藤井圭,大薗慶吾,小原井朋成,成富元,廣田伊千夫,江口徹
日本臨床外科学会雑誌 75(5), 1330-1334, 2014
虫垂炎を契機とし，鼠径ヘルニアを介して陰嚢膿瘍を併発した極めて稀な症例を経験したので報告する．症例は31歳の男性で右陰嚢膨隆・陰嚢痛を主訴とし，当院泌尿器科を受診した．右陰嚢は小児頭大に腫大し，発赤・圧痛・局所熱感を伴っていた．腹部CTでは回盲部付近に15mmの石灰化物と膿瘍形成を指摘，さらに右鼠径ヘルニアと陰嚢膿瘍を認め，穿孔性虫垂炎による腹腔内炎症が右鼠径ヘルニアを介して陰嚢に波及した状態と診 …
NAID 130004706286