Scrotal Problems

Posted by e-Medical PPT Wednesday, January 30, 2013
The scrotum is a protuberance of skin and muscle containing the testicle.
Function is to regulate the temp of the testicles through the cremaster muscle and the dartos fascia in the scrotum.
Ideal temp is about 34.4, > 36.7 may damage sperm count.

Acute scrotal pain
Causes;
Acutely painful scrotum is torsion of testis until proven otherwise.
Strangulated inguino-scrotal hernia is tender, painful, irreducible groin lump.
Torsion of the hydatid of Morgagni
Acute epididymitis
Haematocoele - trauma or scrotal surgery
Fournier’s gangrene-necrotising fasciitis
Appendicitis - referred pain (same visceral afferent nerve supply as testis - T10)

Chronic scrotal pain
Causes;
Inflammation
Chronic bacterial epididymitis
Recurrent incomplete testicular torsion
Chronic scrotal discomfort-in absence of infection. Often hx of scrotal surgery or trauma.
TB

Testicular torsion in newborn infant
Twist of the whole spermatic cord due to unfixed nature of newly descended testis.
Almost all of such torsions present late with overt testicular necrosis
Pain and tenderness are not prominent.
scrotum usually red and swollen and contains hard testicular mass
surgery to excise damaged organ and to fix other testis.

Testicular torsion in older boys and adults
Many cases yearly of ‘epididymitis‘ treated with antibiotics.
Slight left sided bias, incidence higher in winter months
Major predisposing factor is undescended testis
Symptoms include severe testicular pain which may radiate to the groin +/- nausea and vomiting.
Examination - gentle. high riding or horizontal testis. No specific path gnomonic clinical signs to differentiate from epididymitis.
Treatment - successful testicular salvage highly dependent on time b/w start of symptom and surgery. Detorsion and fixation of viable testis. contra lateral testis fixed at same time.
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