Scrotal Abnormalities Flashcards
True/false
Scrotal Trauma
The mobility of the testicle, cremasteric muscle and the tough capsule of the testis are responsible for the infrequent rate of injury to the testis.
true
True/false
For all patients with blunt or penetrating trauma, evaluate Scrotal Trauma before airway breathing, circulation and disability during the primary survey per advanced trauma life support protocol
FALSE
ABCD first
Scrotal skin avulsion/laceration
1) Should be explored and debrided.
2) Managed by housing the testicle in the ______ even if the repair may place the skin under tension
remaining scrotal skin
What usually occurs secondary to a direct blow to the testis impinging against the pubic symphysis (i.e. bicycle injury).
Blunt testicular injury
Laboratory considerations for scrotal trauma
(a) CBC (looking for anemia or infection)
b) UA (looking for hematuria
Imaging considerations for scrotal trauma
Scrotal and testicular ultrasound
Imaging
______ studies can help delineate extent of testicular involvement and evaluate for testicular rupture.
Colored Doppler
True/False
Blunt and penetrating testicular injuries do not require MEDEVAC to urology
False
does require MEDEVAC
For exploration, evacuation of blood clots and repair of testicular rupture
True/False
Lacerations or avulsions just involving the skin can be closed primarily by independent provider.
True
Complications for scrotal trauma
(a) Hematoma infection
(b) Testicular atrophy
(c) Fournier’s gangrene
What is necrotizing fasciitis (polymicrobial infection) of the subcutaneous tissue of the perineum often involving the scrotum
Fournier’s Gangrene
Must maintain a high suspicion for Fournier’s when patients presenting with what?
scrotal, rectal or any genitalia pain out of proportion to their physical exam findings.
Signs and symptoms of what issue
(a) Tense edema of scrotum and other involved skin
(b) Blisters/bullae
(c) Crepitus
(d) Fever
(e) Pain (out of proportion to physical exam)
(f) Tachycardia
(g) Hypotension
Fournier’s Gangrene
Imaging for Fournier’s Gangrene
Computed tomography (CT) and magnetic resonance imaging (MRI) -May show air along the fascial planes or deeper tissue involvement
True/False
Fournier’s Gangrene
Imaging should be obtained prior to surgical exploration when there is clinical evidence of progressive soft tissue infection.
FALSE
Imaging studies should not delay surgical exploration when there is clinical evidence of progressive soft tissue infection
Fournier’s Gangrene Tx
(a) Aggressive surgical exploration and debridement
(b) Broad spectrum antibiotics
- –Ertapenem
(c) Fluid resuscitation
(d) MEDEVAC
Fournier’s Gangrene Complications
Patients may ultimately require:
1) Cystostomy
2) Colostomy
3) Orchiectomy
Fournier’s Gangrene
_______ consultation is often required when periurethral abscess is the inciting event or if the gangrene has invaded the urinary tract.
Urologic
A tense hydrocele or firm spermatocele must be differentiated from what?
tumor
Conditions causing painless scrotal swelling are not true emergencies unless what?
testicular tumors are discovered
which are life threatening and require urgent evaluation (within a few days).
What issue?
Dilation of the pampiniform plexus of spermatic veins and is generally left sided
1) Usually asymptomatic mass; some patients have mild pain.
2) Mass is separate from testis;
3) Feels like “bag of worms,” especially in upright position.
4) Size increased by Valsalva maneuver.
5) Right-sided varicocele should raise suspicion for inferior vena cava and intraabdominal pathology.
6) Sudden left-sided varicocele should raise suspicion for left renal vein obstruction, or renal tumor.
Varicocele
S/s of what issue?
Collection of peritoneal fluid between the parietal and visceral layers around the testes and spermatic cord.
1) Gradually enlarging painless cystic mass that transilluminates
2) May indicate tumor
Hydrocele
S/S of what issue?
Fluid filled cyst at the head of the epididymis that may contain
nonviable sperm.
1) Painless
2) Palpated as distinct from the testis
3) Typically transilluminates as cystic in nature
Spermatocele
What is the diagnostic imaging of choice for scrotal and testicular abnormalities
Ultrasound
Patients with newly diagnosed testicular enlargement or mass lesions should be urgently referred to where?
Urologist
True/False
Malignancy is often very painful
False
often painless