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