History

HPI overview

Core symptom characterization

OPQRST

Onset

Provocation and palliation

Quality

Region and radiation

Severity

Timing

Associated symptoms

Genitourinary

Systemic

Dermatologic and soft tissue

Sexual and exposure history

Sexual exposures

STI risk and prior infections

Recent GU procedures

Pediatric and adolescent specific

Age specific torsion considerations

Activity and exertion triggers

Caregiver timeline reliability

Alarm Features

Time critical diagnoses triggers

Immediate urology activation triggers

Necrotizing infection triggers

Incarceration and ischemia triggers

Vital sign danger thresholds

High risk physiology

High risk exam findings

Scrotal and perineal exam red flags

Abdominal and vascular red flags

Medications

Medication reconciliation

Current medication classes affecting evaluation

Recent antibiotics

Medication related risks

Bleeding and hematoma risk

Immunocompromise and severe infection risk

Analgesia and antimicrobial examples

Analgesia options

Epididymitis likely STI coverage

Epididymitis likely enteric coverage

Local protocol dependent

Diet

Recent intake and hydration

Intake pattern

Hydration indicators

Exposures relevant to differential

Alcohol and substances

Caffeine and energy drinks

Review of Systems

Constitutional and infectious

Systemic symptoms

Genitourinary

Urinary tract symptoms

Reproductive symptoms

GI and vascular

Abdominal symptoms

Vascular symptoms

Collateral History and Family History

Collateral source

Source and reliability

Family history

Relevant inherited conditions

Early cardiovascular disease history

Risk Factors

Torsion and anatomic risks

Torsion risk factors

Infection and necrotizing infection risks

Epididymo orchitis risk factors

Fournier gangrene risk factors

Trauma and bleeding risks

Trauma risks

Bleeding risks

Differential Diagnosis

Life threatening

Cannot miss

Common

High frequency etiologies

Less common and mimics

Other considerations

Past Medical History

Prior genitourinary history

Relevant prior conditions

Prior procedures

Chronic disease modifiers

Comorbidities increasing risk

Baseline functional status

Physical Exam

Initial appearance and vitals interpretation

General

Vital sign patterns

Abdominal and groin

Abdomen

Groin and hernia

Genital exam

Inspection

Palpation

Reflexes and signs

Perineum

Rectal exam when indicated

Prostate and anorectal

Lab Studies

Urine and STI testing

Urinalysis with microscopy

Urine culture

NAAT for gonorrhea and chlamydia

Bloodwork for systemic illness

CBC

BMP

CRP

Lactate

Pre procedure and severe infection labs

Coagulation studies

Type and screen

Blood cultures

Imaging

Scoring Systems

Risk stratification tools

MRI

MRI pelvis or scrotum considerations

CT

CT abdomen pelvis indications

CT precautions

Ultrasound

Scrotal ultrasound with Doppler

Ultrasound pitfalls

POCUS role

Special Tests

Bedside maneuvers and signs

Torsion related bedside findings

Epididymitis related bedside findings

Procedural and adjunct tests

Transillumination

Hernia reduction attempt considerations

Manual detorsion considerations

ECG

When ECG is relevant

Indications

High risk patterns when obtained

Ischemia and instability patterns

Assessment

Working diagnosis and severity

Testicular torsion probability

Infection severity

Complications to rule out

Threats to organ viability

Systemic threats

Diagnostic uncertainty and pitfalls

Pitfall checks

Plan

First 5 minutes and critical pathway

Immediate priorities

Time critical consult triggers

Diagnostic sequencing

High torsion suspicion

Intermediate torsion suspicion

Infection suspected

Therapeutics

Analgesia

Antibiotics for epididymitis

Fournier gangrene pathway

Monitoring and reassessment loop

Reassessment timing

Escalation triggers

Disposition

ICU and resuscitation level care

ICU criteria

Admission and operative pathways

Admission indications

Operative timing considerations

Discharge and observation

Discharge criteria

Observation pathway criteria

Discharge Instructions

Copy discharge instructions

Scrotal pain evaluation completed today

Medications

Activity

Follow up

Return to ED now for

References

Guidelines and key sources

Core references