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Urology YR3 > Scrotal pain > Flashcards

Scrotal pain Flashcards

1
Q

Layers of scrotum

A
  • Skin
  • Superficial “Dartos” fascia
  • External spermatic fascia
  • Cremaster muscle
  • Internal spermatic fascia
  • Tunica vaginalis
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2
Q

What is cremasteric reflex?

A
  • Stroking proximal and medial thigh
  • Normal response = contraction of cremater muscle causing retraction of testes upwards on ipsilateral side
  • Absence of this reflex = sign for torsion
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3
Q

What is Phrens sign?

A
  • Alleviation of scrotal pain by lifting testes
  • Suggestive of acute epididymitis
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4
Q

Investigations for scrotal pain - bloods and bedside

A
  • Urine dipstick
  • Urine MC&S
  • Urethral swab if suspect STI
  • Bloods - FBC, CRP, U&E
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5
Q

Imaging for scrotal pain

A
  • USS scrotum
  • Identify inflammatory process and patency of blood vessels
  • BUT if suspect torsion - do not delay surgical exploration for imaging
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6
Q

Differentials for scrotal pain

A
  • Testicular torsion
  • Torsion of testicular and epididymal appendages
  • Epididymitis
  • Testicular cancer
  • Non-urological - Henoch-Schoenlein Purpura, viral orchitis
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7
Q

Testicular torsion - what is it

A
  • Twisting of spermatic cord
  • Occlusion of testicular and cremasteric arteries
  • = ischaemia and subsequent testicular infarction
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8
Q

History for testicular torsion

A
  • Young adults
  • Pain sudden onset
  • Very severe
  • N+V
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9
Q

Examination testicular torsion

A
  • Unilateral scrotal tenderness
  • High testicular position
  • Abnormal lie
  • Absent cremasteric reflex
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10
Q

Management testicular torsion

A
  • Urgent surgical exploration
  • If torsion present - untwist
  • If return of vascularity –> bilateral orchidopexy (fix teste to scrotum)
  • Orchidectomy if infarcted, fix contralateral testicle
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11
Q

What is torsion of testicular and epididymal appendages?

A
  • Hydatid of Morgagni = testicular appendix
  • This and epididymal appendage are remnants of embryological development
  • They can twist and result in torsion
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12
Q

Presentation testicular torsion vs torsion of appendages

A
  • Appendages = normal testicular lie and present cremasteric reflex
  • BUT both present with unilateral scrotal pain and tenderness
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13
Q

What is blue dot sign?

A
  • Upper half of hemi scrotum
  • Occurs due to infarction of appendices
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14
Q

Management of torsion of testicular and epididymal appendages

A
  • Analgesia
  • BUT if clinical uncertainty, need surgical exploration to rule out testicular torsion
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15
Q

What is epididymitis?

A
  • Inflammation of epididymis
  • Most common cause sexual transmission in under 35
  • If above 35, likely enteric organism from UTI
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16
Q

Presentation of epididymitis

A
  • Worsening pain in scrotum - can spread to groin
  • Fevers
  • Dysuria
  • Urethral discharge
17
Q

Examination of epididymitis

A
  • Epidiymis affected is swollen and tender - unilateral
  • Overlying scrotal skin looks inflamed
  • Cremasteric reflex present
  • Prehns sign positive
18
Q

Management of epididymitis

A
  • Antibiotics
  • If STI - organism unknown = IM ceftriaxone + doxycycline BD for 2 weeks
  • UTI - organism unknown = quinolone for 2 weeks eg ofloxacin
19
Q

How can testicular cancer present with pain?

A
  • Usually painLESS
  • Acute scrotal pain if internal haemorrhage within malignancy
  • Pain associated with palpable mass
20
Q

+ve Investigations for testicular cancer

A
  • USS testes definitive
  • Raised tumour markers eg b-HCG and AFP
21
Q

Management of testicular cancer

A
  • Surgical - radical inguinal orichidectomy
  • May need adjuvant chemotherapy
22
Q

Referred pain causing scrotal pain

A
  • Anterior scrotum = supplied by branches of genitofemoral and ilioinguinal nerve
  • Posterior = perineal branches of pudendal and posterior femoral cutaneous nerve
  • Things such as ureteric stones or strangulated inguinal hernia can irritate these nerves and cause pain
23
Q

What is Henoch-Shoenlein Purpura?

A
  • IgA mediated
  • Small vessel vasculitis
  • Commonly affects skin, mucous membranes and kidneys
24
Q

Triad of HSP

A
  • Purpuric rash on limbs
  • Arthiritis
  • Abdominal pain

Can present in some cases with scrotal symptoms inc pain, erythema and swelling

25
Q

Bloods and definitive diagnosis for HSP

A
  • Raised CRP or ESR
  • Raised serum IgA
  • Diagnosis made via biopsy to kidney or skin - shows IgA deposition
26
Q

What causes viral orchitis?

A
  • Inflammation of testes due to viral infection
  • Most common = mumps
27
Q

Presentation of viral orchitis?

A
  • Bilateral scrotal pain - unlike other causes
  • Scrotal swelling and pain 4-8 days following parotitis
28
Q

Management viral orchitis

A
  • Analgesia
  • Self limiting
  • BUT scrotal swelling may persist up to 6 weeks post infection
29
Q

When to US suspected testicular torsion

A
  • If present within 48hrs - no just straight to surgery
  • If >48hrs history - US testis can support diagnosis of delayed presentation or identify other cause
30
Q
A

Urology YR3 (27 decks)

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