Scrotal pain/swelling

DDx of scrotal mass:

• • Cancer

  • Torsion, epididymitis, epididymorchitis, hydrocele, spermatocele, varicocele, inguinal hernia, mumps, testicular appendage, swollen testicle after trauma, non-testicular tumor (paratesticular tumor: e.g., rhabdomyosarcoma, leiomyosarcoma, liposarcoma)

Torsion of spermatic cord resulting in venous outflow obstruction and subsequent arterial occlusion → infarction of testicle.

Onset of scrotal pain usually after vigorous activity or minor trauma

Usually seen in adolescence

Bell clapper deformity: b/l nonattachment of the testicles by the gubernaculum of the scrotum (free like the clappers of a bell)

Pain in scrotum, suprapubic pain, tender swollen testicles, elevated testicles, nonillumination, absence of cremasteric reflex

U/S and doppler flow study, cold Tc-99m scan (nuclear study), surgical exploration

Tx: surgical detorsion and b/l ochiopexy to the scrotum.

less than 6 hr will bring the best result; >90% salvage rate. After 24 h <10% salvage rate.

epididymitis is inf of epididymis. Swollen, tender testicle; dysuria, scrotal ache/pain, fever, chills, scrotal mass. Bacteria in urethra. E. coli, Gonorrhea, chlamydia.

UA, urine cx, swab if STI suspected. U/S w/ dopper, nuclear study.

Abx.

Phren's sign: elevation of the painful testicle, reduces pain of the epididymitis

Fournier's gangrene: extensive tissue necrosis/infection of the perineum in patients with diabetes.