Acute Scrotal Pain
spermatocele
a benign cyst that develops in the epididymis and is filled with a milky fluid containing sperm
Crepitus
a grating sound or sensation produced from air under the skin from gangrene
varicocele
enlarged veins of the spermatic cord, most often occurs on the left, venous return is more difficult bc it drains into left renal vein
clinical presentation of varicocele
feels like "bag of worms"
Fournier gangrene
form of necrotizing fasciitis that is localized to scrotum and perineal area
hydrocele
painless fluid collection in the scrotum, caused by congenital abnormality of communication between tunica vaginalis and peritoneal cavity (transillumination positive)
testicular torsion occurence
spontaneously, peaks at first year of life and at puberty, emergency, can be salvaged if caught within hours
scrotal abscess
superficial warm, red, tender, purulent
scrotal cellulitis
superficial, warm, red, tender, antibiotic treatment
testicular dislocation
testicle pushed into inguinal region, ultrasound to assess viability, can be reduced at bedside or taken to OR
bell clapper deformity
tunica vaginalis extends upward to the spermatic cord, leaving the testicle vulnerable to torsion
What occurs in testicular torsion
twisting of the spermatic cord, causes venous congestion, then reduced arterial blood flow, creates ischemia
Appendage torsion
twisting of the testicular epididymal appendage, not an emergency, more superior tenderness, can have "blue dot sign"
diagnosing testicular issues
ultrasound is first line, can do CT to differentiate cellulitis of scrotum from gangrene
PE of testicular torsion
unilateral testicular elevation, horizontal axis, tender testicle, absent cremasteric reflex (usually testicle is twisted medially)
epididymitis in adults
usually caused by Chlamydia and gonorrhea
tunica albuginea
white fibrous capsule on testes
dartos muscle
smooth muscle; wrinkles scrotal skin; pulls scrotum close to body
testicular malignancy
-most common 20-34 y/o -nontender mass -firm, non-moveable mass -may have constitutional symptoms (night sweats, unintentional weight loss)
possible causes of painless swollen scrotum
-testicular malignancy -hydrocele -varicocele -spermatocele
Epididymis
A long, coiled duct on the outside of the testis in which sperm mature.
diagnosing fournier gangrene
CT of testicles to differentiate from scrotal cellulitis
testicular rupture
Disrupted tunica albuginea, requires surgery
most common cause of epididymitis in men older than 35
E. coli
Epididymitis/orchitis
Inflammation of epididymis &/or testes, gradual onset, can have fever, dysuria, discharge, etc, posterior testicular pain
cremaster muscle
Muscle that pulls the scrotum closer to the body in cold temperatures and relaxes to let the testicles be farther away from the body in warmer weather
Prehn sign
Pain relieved upon elevation of testicle when patient is supine (Positive test)
efferent ductules
about 12 small ciliated ducts collecting sperm from rete testes and transporting it to epididymis
Hematocele
accumulation of blood around the testicles, does not transilluminate, doesn't require emergent surgery, just monitor
tunica albuginea vs tunica vaginalis
albuginea surrounds testicle, tunica vaginalis extends into peritoneum
spermatic cord
collection of vas deferens, blood vessels, lymphatics, and nerves that ascends along the testis and through the inguinal canal into the abdomen
epididymitis in pediatrics
post viral, can have isolated orchitis from mumps
raphe
seam of fibrous tissue