Code Status case · Beginner · Premium
Testicular pain in a 21-year-old man
“The pain woke me up. My left testicle really hurts.”
“Sudden, severe left testicular pain woke him about two hours ago. Vomited once. He's lying very still and looks extremely uncomfortable.”
Your challenge
Sudden testicular pain in a young man has a short list of causes, and at the bedside they can look alike: an infection, a kidney stone, a hernia, or something that needs surgery within hours. Ethan is in pain and embarrassed to be examined. You decide what to ask, how to examine him, and whether a test will help or only cost time. The clock started when the pain woke him, not when he walked in.
After the case, Attending’s Notes explains the decisions that mattered, backed by 10 sources.
Ready to make the call?
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Spoiler: the diagnosis and what this case teaches
Diagnosis
Testicular Torsion
Lesson 1
Ethan's Story Pointed to Torsion
A previous episode of sudden testicular pain that resolved suggests intermittent torsion.
- Sudden severe testicular pain that woke him
- Nausea and vomiting with the pain
- A similar episode of pain that resolved last month
- High-riding testis and absent cremasteric reflex
Lesson 2
Torsion Is a Clinical Diagnosis
When suspicion is high, don't let imaging delay surgery.
- A normal cremasteric reflex does not exclude it
- No blood test or urinalysis can rule out torsion
- Preserved Doppler flow does not exclude torsion
- Use Doppler ultrasound if the diagnosis is unclear
Lesson 3
Time Is Testicle
The longer the delay, the lower the chance of saving the testis. Surgery is still urgent.
- Call Urology the moment you suspect torsion
- Treat pain early, keep NPO, start an IV
- Surgery untwists the cord and secures the testis
- Manual detorsion is a bridge, never the cure
Lesson 4
Beyond the Emergency
Pain relief doesn't mean the danger has passed. Surgery reduces the risk of recurrence, and follow-up matters.
- Pain that eases on its own still needs Urology
- Both testes are usually fixed during surgery
- Follow-up checks healing, function and fertility
- A testis that cannot recover may be removed
In the app, every line above opens into the detail behind it: doses, pitfalls and the evidence, with 10 sources linked to the originals.
Ethan is a fictional patient. Code Status is for training only and is not intended for real-world patient care, diagnosis, treatment, or clinical decision-making.