Scrotal & Testicular Disorders Flashcards
1
Q
Describe conditions that may produce acute scrotal pain or swelling?
A
- Testicular torsion
- torsion of testicular appendices
- epidiymitis
- orchitis
- testicular tumor
- scrotal trauma
- hernia
- fournier’s gangrene
2
Q
non-acute scrotum masses
A
- varicocele
- hydrocele
- spermatocele
- epididymal cyst
- early stage testicular cancer
3
Q
- urological emergency= Emergent urology consult
- rotation of the testicle along its vertical axis around the spermatic cord can constric the testicular artery and cause ischemia
- risk factors: Cryptochidism, genetic structural defects such a “bell clapper deformity (tunica vaginalis covers the entire testicle and epididymis, preventing fixation to the posterior wall and causing the testicle to rotate freely
A
Testicular torsion
4
Q
signs and symptoms of testicular torsion
A
- acute onset; severe, unilateral scrotal pain +/- edema, N/V
- possible history of previous intermittent torsion
- firm tender, high-riding horizontal lie of testicle from the shortened spermatic cord
- absent cremasteric reflex (does not raise)
- absent prehn sign (pain does not improve)
- epididymis is not posterior to the testis
- can be intermittent and spontaneously resolve
5
Q
diagnosis and treatment of testicular torsion
A
- clinical suspicion, mostly a diagnosis based on exam
- imaging: Color Doppler ultrasound- preferred initial diagnostic test
- Surgery is the definitive treatment
Treatment
- emergent bilateral orchiopexy
- if treatment delayed- attempt manuel detorsion (twist affected testicle in outward motion)
6
Q
- pain is localized in the upper pole of the testicle
- acute unilateral testicular pain
- diagnosis: blue dot sign, a nodule with blue discoloration in the upper scrotum, especially in light skinned pts.
- ultrasound is useful to rule out concurrent testicular torsion or epididymitis
- tx: conservative: NSAID and bed rest if dx can not be made with confidence, surgical intervention may be necessary
A
Appendix testis
7
Q
- inflammation of the epididymis or epididymo-orchitis
- most common cause of acute scrotum
- etiology: infectious most common bacterial (most common)
- < 35 y/o most common causes are chlamydia trichromatic and Neisseria gonorrhea
- > 35 y/o: most common cause of epididymitis is UTI or bladder stasis secondary to BOO, which may present in combo with prostatitis (e. coli, psedomonas, and gram + cocci)
- anal intercourse history- consider coliform bacteria from the rectum
Noninfectious- malignancy, trauma, chemical
A
Epidiymitis & epididymoorchitis
8
Q
diagnosis of epididymitis & epididymo-orchiits
A
diagnosis
- the clinical presentation is similar to testicular torsion- unilateral scrotal pain, erythema, and edema; however, the onset of pain is usually progressive or gradual, not acute
- positive cremasteric reflex
- indurated, tender, or swollen epididymis
- labs: UA & urine C/S (pyuria/bacteriuria); STI screening (urethral swab PCR vs urine) WBC- leukocytosis, elevated CRP/ESR
9
Q
How can you distinguis epididymitis from testicular torsion via ultrasound?
A
- increased blood flow/ hyperemia to the epididymis
10
Q
treatment of epididymitis & epididymo-orchitis?
A
- RICE + NSAIDs + antibotics based on most likely etiology
- < 35 y/o ceftriaxone 250mg IM + doxycycline 100mg PO bid x 10d or azithromycin 1g PO
- > 35y/o cipro 500mg bid x 10d or levofloxacin 500mg x 10d; TMP-SMX if allergy
- if anal intercourse- ceftriaxone 250mg IM + levofloxacin 500mg x 10 days
- septic presentation –> admit for IV antibiotics
swelling typically improves within 3 days, pain may linger weeks/mon
11
Q
- necrotizing fasciitis of male genitalia and perineum
- life threatening urological emergency
- pain, swelling and erythema of the scrotal skin and surrounding affected areas; those with more severe infection will have skin necrosis, hemorrhagic bullae and symptoms of septic shock
- crepitus from gas producing bacteria
- pathogens include e.coli (most common) streptococcus pyogenes, staph aureus and MRSA
A
Fournier’s gangrene
12
Q
risk factors and treatment for fournier’s gangrene?
A
Risk factors:
Obesity, DM, chronic indwelling catheters
EtOH, IV drug users
immunocompromise (HIV, immunosuppressants, chemo, surgical pts)
Treatment
- IV ampicillin or clindamycin. A gram stain and C&S-to guide therapy, emergent surgical debridement is crucial to explore the extent of necrosis and debride affected sites to limit extent
13
Q
- protrusion in the inguinal canal due to fascial defect
- variable presentation (asymptomatic/benign to life-threatening and painful. incarcerated=ischemia= bowel death
A
inguinal hernia
14
Q
- lateral to the inferior epigastric vessels to enter the deep inguinal ring
- most common (2/3)
- congenital patency to the processus vaginalis
- mostly pediatric
A
indirect hernia
15
Q
- medial to the inferior epigastric vessels
- acquired- heavy lifting
A
Direct hernia
