Urology

This patient is most likely to have pain relief with testicular elevation (Prehn sign). His history and examination findings (erythema and swelling of the hemiscrotum; fever; tenderness to palpation near the epididymis; and lack of worsening symptoms, nausea, vomiting, and abdominal pain) suggest a diagnosis of epididymitis. Prehn sign, which is alleviation of pain with elevation of the testicle or scrotum, can clinically support this diagnosis. Although this finding can suggest a diagnosis of epididymitis, it does not rule out other possibilities, such as testicular torsion; however, testicular torsion is less likely given this patient's presentation.

An absent cremasteric reflex suggests testicular torsion. A patient with testicular torsion would have acutely worsening and severe hemiscrotal pain, hemiscrotum elevation, abdominal pain, nausea, and vomiting. These findings are not present in this patient, and the test result would likely be negative.

A transillumination study, which is performed to identify a hydrocele, is not likely to have a positive result in this patient with findings that suggest epididymitis. A hydrocele manifests over a longer time frame, initially causing no symptoms and then causing a dull aching scrotal discomfort. Examination can reveal a smooth though tense scrotal mass, which transilluminates when a light source is applied adjacently.

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