Patient handout

Acute scrotal pain — pivot / triage workup (routes to torsion / epididymitis / Fournier / urolithiasis / appendix testis)

PRODUCTION

1. Your condition

This handout is for acute scrotal pain — pivot / triage workup (routes to torsion / epididymitis / fournier / urolithiasis / appendix testis). Your care team identified this based on: acute scrotal pain (any onset pattern) — pivot triage (aua 2017 acute scrotum).

Other reasons your team may use this plan: scrotal pain with n/v — torsion-suspect (barbosa twist 2013); adolescent male with isolated lower-abdominal pain — examine scrotum (aua 2017); scrotal pain + dysuria / fever — epididymitis-suspect (cdc sti 2021).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
acetaminophen	15 mg/kg PO/IV (max 1 g/dose adult)	PO/IV	q6h, max 4 g/day adult	Multimodal opioid-sparing analgesia (AUA 2017)
morphine	0.1 mg/kg IV (typical 4–10 mg adult)	IV	q3–4h PRN	Severe acute pain (AUA 2017)
fentanyl	1 µg/kg IV (typical 25–100 µg adult)	IV	q5–15 min PRN	Short-acting opioid for titration (AUA 2017)
ondansetron	4 mg IV (peds 0.15 mg/kg, max 4 mg)	IV	q8h PRN	Symptom control for N/V (AUA 2017)
Lactated Ringer solution	500–1000 mL bolus	IV	continuous	Pre-OR resuscitation if route → OR (AUA 2017). non_pharm: multi-component crystalloid without a single RxNorm ingredient code.

Plan: Acute scrotal pain — in-ED bridge supportive care while routing to terminal engine (AUA 2017)

3. When to call your provider

Contact your care team if any of the following happen:

New severe scrotal pain → STAT ED (AUA 2017)
Fever or systemic features → STAT ED (AUA 2017)
Persistent symptoms beyond expected → uro re-evaluation (AUA 2017)

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

TWIST 5–7 OR pain ≤6 h + classic features (sudden, N/V, absent cremasteric, high-riding) → torsion route (Barbosa 2013; AUA 2017)(life-threatening)
TWIST 3–4 → high-resolution scrotal POCUS Doppler; if absent intratesticular flow → torsion route (Friedman 2017; AUA 2017)
Crepitus + perineal necrosis + sepsis features → Fournier pathway (STAT broad-spectrum antibiotics + emergent surgical debridement + ICU likely) (AUA 2017)(life-threatening)
Trauma + heterogeneous parenchyma / contour disruption on POCUS → uro OR for testicular rupture (AUA 2017)
Tender groin mass + scrotal extension + bowel symptoms → general surgery STAT (AUA 2017)

5. Follow-up

Per terminal-diagnosis engine; uro 1–2 wk; STI testing follow-up if epididymitis; psychological support if orchiectomy (Arap 2015)

6. Sources

Guideline: Testicular torsion is a time-critical surgical emergency (salvage falls sharply after ~6 h). Barbosa TWIST clinical score (J Urol 2013 PMID 23103800) for risk stratification; acute-scrotum etiology/management (Indian J Pediatr 2005 PMID 15812112); evaluation of scrotal masses (Am Fam Physician 2008 PMID 19035065). Epididymitis antibiotic therapy follows CDC STI Treatment Guidelines 2021 (cited by name); routes to uro.epididymitis-orchitis.v1.