Key clinical principles

Acute scrotal pain is torsion until proven otherwise.
Young age does not exclude serious pathology.
Delayed presentation remains a major contributor to testicular loss.
When uncertainty exists, early evaluation is preferable to delayed reassurance

Features that should raise suspicion include:

A firm or enlarging intratesticular mass
Persistent unilateral scrotal discomfort
Testicular asymmetry or induration
Associated back pain, cough, or weight loss (suggesting metastatic disease

Common etiologies include:

Testicular torsion
Epididymitis and orchitis
Trauma-related injury
Torsion of testicular appendages
Inguinal hernia
Varicocele or hydrocele
Referred pain from renal or musculoskeletal sources

While many underlying causes are benign and self-limiting, others, most notably testicular torsion, represent true urologic emergencies in which delayed intervention can result in irreversible testicular damage

Physicians: we have an ethical obligation to stand in solidarity with nurses. Nursing is a profession worthy of resources and respect. If we can’t say that out loud, we’re not practicing justice, we’re enforcing hierarchy.