Introduction

Scrotal emergencies frequently result in a call to the urologist. It is important to remember that emergencies that involve the scrotum maybe confined to scrotal structures or referred from other sources. There are a number of differential diagnoses to consider (Table 12.1), as the scrotum itself contains numerous structures: the testicles, epididymis, spermatic cord, and the scrotal tissue itself, comprised of several muscular and fascial layers. Without a thorough differential diagnosis of intrinsic and extrinsic causes of scrotal pain, a diagnosis may be missed. Careful history tak-

Table 1. Differential diagnosis of scrotal pathology Painless scrotal masses

Inguinal hernia (nonstrangulated, nonincacerated)

Testicular tumors (these may also be painful)

Hydrocele

Spermatocele

Varicocele

Paratesticular tumors/masses Scrotal edema

Epididymal caput distension from bilateral congenital absence of the vas

Painful scrotal masses

Inguinal hernia (incarcated or strangulated) Testicular tumors Testicular torsion

Appendicial torsion (of testicular appendages)

Epididymitis

Epididymo-orchitis

Trauma

Dermatological lesions Inflammatory vasculitis Hematocele

Miscellaneous

Empty scrotum (cryptorchidism)

Table 2. Findings on evaluation for common scrotal emergencies

Pathology

Pain

Illumination

Urin-alysis

Ultrasound

Dopp-ler

Epididy-mitis

Yes

No

Abnormal

Heteroge-nous testis echotexture

Increased flow

Inguinal hernia

Maybe

Maybe

Normal

Hernia sac

Normal

Hydro-cele

No

Yes

Normal

Fluid without echos

Normal

Sperma-tocele

No

Maybe

Normal

Fluid usually with echos

Normal

Testicular rupture

Yes

No

Normal

Heterogeno-us testicle Possible incomplete tunica

Usually abnormal

Testicular tumor

Maybe

No

Normal

Heterogeno-us echotex-ture

Normal

Testicular torsion

No

No

Yes

Normal

Decreased Flow

ing, directed physical exam, and urinalysis with the occasional use of Doppler ultrasound can discriminate between processes quite effectively (Table 12.2). In the hierarchy of concern when dealing with scrotal emergencies, the testicle assumes the position of importance, as loss of a testicle from torsion or failure to diagnose a testicular tumor carry disastrous consequences. Scrotal examination therefore absolutely must document the presence and characteristics of the testicles.

0 0

Post a comment