Testicular Abscess Diagnosis and Treatment in Singapore

• Men experiencing severe, persistent testicular pain with swelling
• Individuals with fever and scrotal tenderness following urinary tract infections
• Patients with worsening symptoms despite antibiotic treatment for epididymo-orchitis
• Those with testicular trauma showing signs of infection
• Men with recurrent epididymitis not responding to conservative treatment
• Patients with underlying conditions predisposing to urogenital infections
• Individuals with scrotal swelling and systemic signs of infection

• Diabetes mellitus or other immunocompromising conditions
• Recent urological surgery or instrumentation
• Chronic indwelling urinary catheters
• Sexually transmitted infections, particularly gonorrhoea or chlamydia
• Urinary tract abnormalities or obstruction
• Previous episodes of epididymo-orchitis
• Trauma to the scrotal region

• Large abscesses (>2cm) unlikely to respond to antibiotics alone
• Signs of testicular ischaemia or infarction
• Sepsis or systemic infection requiring urgent intervention
• Failed medical management after 48-72 hours
• Multiple or multiloculated abscesses
• Significant destruction of testicular parenchyma

Our MOH-accredited urologists will conduct a thorough evaluation to determine the appropriate treatment approach based on your specific presentation and overall health status.

For small, uncomplicated testicular abscesses detected early, antibiotic therapy may be sufficient. This approach involves broad-spectrum antibiotics targeting common causative organisms including E. coli, Klebsiella, and Staphylococcus species. Patients receive intravenous antibiotics initially, followed by oral therapy for 2-4 weeks. Regular ultrasound monitoring assesses abscess resolution and guides treatment duration.

Ultrasound-guided percutaneous drainage offers a minimally invasive option for accessible abscesses. This technique involves inserting a needle or small catheter into the abscess cavity under ultrasound guidance to evacuate pus. The procedure can be performed under local anaesthesia with sedation. Following drainage, the cavity may be irrigated with antibiotic solution. This approach preserves testicular tissue and may be repeated if necessary.

Open surgical drainage remains the definitive treatment for large or complex abscesses. The procedure involves making an incision through the scrotal skin and underlying layers to access the abscess. The surgeon evacuates all purulent material, removes necrotic tissue, and irrigates the cavity thoroughly. Drain placement ensures continued drainage postoperatively. This approach allows direct visualisation and complete debridement of infected tissue.

In severe cases with extensive testicular destruction or when the testis is non-viable, orchiectomy (testicular removal) may be necessary. This decision considers factors including the extent of parenchymal damage, patient age, contralateral testicular function, and infection severity. The procedure involves complete removal of the affected testis and spermatic cord to the level of the internal inguinal ring.

Modern diagnostic and treatment approaches utilise high-resolution scrotal ultrasound with colour Doppler imaging for accurate abscess localisation and monitoring. Bacterial culture and sensitivity testing guide antibiotic selection. Surgical procedures employ microsurgical techniques when testicular preservation is attempted, using operating microscopes for precise tissue handling.

Initial evaluation includes comprehensive history taking and physical examination to assess symptom duration and severity. Blood tests evaluate infection markers including white blood cell count, C-reactive protein, and blood cultures if systemic infection is suspected. Urine analysis and culture identify potential urinary tract infections. Scrotal ultrasound with Doppler confirms the diagnosis and determines abscess characteristics.

Patients receive pain management and fever control while awaiting definitive treatment. Scrotal support and elevation help reduce discomfort. For surgical candidates, preoperative assessment includes anaesthetic evaluation and consent discussion. Fasting guidelines apply for procedures requiring general or regional anaesthesia.

For percutaneous drainage, patients lie supine with the scrotum prepared and draped steritely. Local anaesthetic infiltration provides pain control. Under ultrasound guidance, the urologist advances a needle into the abscess cavity, aspirating pus for culture before complete evacuation. The procedure typically takes 20-30 minutes.

Surgical drainage under general or spinal anaesthesia involves a transverse scrotal incision over the point of maximum fluctuation. The surgeon carefully dissects through tissue layers, identifying and opening the abscess cavity. Complete evacuation of purulent material follows, with extensive irrigation using antibiotic solution. Necrotic tissue undergoes debridement while preserving viable testicular tissue when possible. The procedure duration ranges from 30-60 minutes depending on complexity.

Following the procedure, patients recover in a monitored setting with vital sign assessment and pain management. Ice packs applied intermittently help reduce swelling and discomfort. Scrotal support provides comfort and minimises tissue movement. Antibiotic therapy continues based on culture results.

For surgical cases, wound care instructions include keeping the area clean and dry. Drain management involves monitoring output and maintaining patency. Most patients can be discharged the same day or after overnight observation. Clear instructions regarding warning signs requiring immediate medical attention are provided, including increased pain, fever, or excessive bleeding.

Immediate post-procedure care focuses on pain control using prescribed analgesics and anti-inflammatory medications. Scrotal elevation and support remain important for comfort and swelling reduction. Ice application for 20 minutes every 2-3 hours helps minimise inflammation. Activity restriction includes avoiding heavy lifting and strenuous exercise.

Patients monitor for signs of complications including increased swelling, fever above 38.5°C, or purulent drainage. Antibiotic compliance is crucial during this period. Gentle wound care involves keeping the surgical site clean and dry. Showering is typically permitted after 24 hours with careful pat-drying of the area.

Daily wound inspection ensures proper healing without signs of infection. Drain output gradually decreases, with removal typically occurring 3-5 days post-surgery when drainage is minimal. Follow-up appointments allow wound assessment and suture removal if non-absorbable sutures were used.

Gradual activity resumption begins with light walking encouraged to prevent complications. Scrotal support continues during ambulation. Sexual activity should be avoided until cleared by the urologist. Antibiotic therapy continues as prescribed, typically for 2-3 weeks total duration.

Complete healing typically occurs within 4-6 weeks. Return to normal activities including exercise and sexual function usually resumes after 3-4 weeks, depending on the extent of surgery. Follow-up ultrasound at 6-8 weeks confirms resolution and assesses testicular viability.

Long-term monitoring includes periodic assessment of testicular function and size. Fertility evaluation may be recommended if future paternity is desired, particularly after extensive surgery. Preventive measures to avoid recurrence include treating underlying urological conditions and maintaining good genital hygiene.

Temporary scrotal swelling and bruising occur in most patients, typically resolving within 1-2 weeks. Mild to moderate post-procedural pain is expected, manageable with prescribed medications. Surgical site tenderness may persist for several weeks. Minor bleeding or blood-tinged drainage from the incision is common initially.

Temporary reduction in testicular size may occur due to inflammation, often improving over months. Some patients experience altered scrotal sensation that gradually normalises. These effects are generally well-tolerated and resolve with conservative management.

Wound infection occurs in less than 5% of cases, requiring additional antibiotic therapy or drainage. Haematoma formation may necessitate evacuation if large or symptomatic. Recurrent abscess formation, while uncommon, may require repeat intervention. Testicular atrophy can occur despite successful infection treatment, particularly with large abscesses.

Chronic pain syndromes develop rarely but may require long-term pain management. Infertility risk exists, particularly with bilateral disease or extensive testicular damage. Wound dehiscence or poor healing may occur in diabetic or immunocompromised patients.

Our MOH-accredited urologists employ meticulous surgical technique and comprehensive perioperative care to minimise these risks. Careful patient selection, appropriate antibiotic therapy, and close follow-up help ensure positive outcomes while reducing complication rates.