Approach to Male Urologic Emergencies

2019 ◽  
Author(s):  
Jonathan E. Davis ◽  
Jeffrey S. Dubin
Keyword(s):  
Emergency Department ◽  
Inguinal Hernia ◽  
Necrotizing Fasciitis ◽  
Testicular Torsion ◽  
Diagnosis And Treatment ◽  
Acute Scrotum ◽  
Scrotal Pain ◽  
Penile Pain ◽  
Emergency Department Setting ◽  
Acute Scrotal Pain

This review details the evaluation and management of the acute scrotum in the emergency department setting and emergent penile complaints in adults, with an emphasis on the most serious and most common conditions. Other emergent conditions include necrotizing fasciitis of the perineum (Fournier disease), incarcerated or strangulated inguinal hernia, and genitourinary (GU) trauma. Emergency practitioners need to be most concerned with the entities that, if left untreated, can result in ischemia and necrosis of the penis. Basic anatomy and bedside evaluation are reviewed. Acute scrotal and penile pain and GU trauma are discussed in terms of assessment and stabilization, diagnosis, and treatment and disposition.  This review contains 5 figures, 19 tables, and 71 references. Keywords: Acute scrotal pain, testicular torsion, priapism, Peyronie disease, paraphimosis, phimosis, balanitis, posthitis, epididymitis

scholarly journals Real-time Point-of-care Ultrasound for the Diagnosis and Treatment of Testicular Torsion

POCUS Journal ◽  
2021 ◽  
Vol 6 (2) ◽  
pp. 70-72
Author(s):  
Rahul V. Nene ◽  
Rachna Subramony ◽  
Michael Marcias ◽  
Colleen Campbell ◽  
Amir Aminlari
Keyword(s):  
Blood Flow ◽  
Real Time ◽  
Testicular Torsion ◽  
Point Of Care ◽  
Diagnosis And Treatment ◽  
Acute Scrotum ◽  
Point Of Care Ultrasound ◽  
Scrotal Pain ◽  
Real Time Analysis ◽  
Acute Scrotal Pain

Background: Testicular torsion is a surgical emergency that needs prompt diagnosis and treatment. Point-of-Care ultrasound (POCUS) can not only establish the diagnosis but also guide the Emergency Physician in evaluating the response to manual detorsion. Case Report: We describe the case of a 13-year-old male who presented with acute scrotal pain. We demonstrate how bedside ultrasound was used to make the diagnosis of testicular torsion, guide the technique for manual detorsion, and confirm adequate return of blood flow. Our case illustrates the ease with which POCUS can be used in real time to diagnose and treat organ-threatening pathology, but more importantly, it shows how real-time POCUS was used to detorse a testicle that was refractory to the standard detorsion technique. Conclusion: The acute scrotum is a time-sensitive presentation and if testicular torsion is present, the diagnosis should be made as soon as possible. Many Emergency Departments do not have 24-hour coverage of ultrasound technicians, which would delay the diagnosis and treatment. Moreover, when manual detorsion is attempted, it often does not work because the testicle may need more than the standard 180 degree medial to lateral rotation. POCUS provides real-time analysis of return of blood flow and can thus guide further rotation, or opposite direction rotation, as needed.  

scholarly journals Bilateral Epididymal Cyst in 14 year-old Boy: a case report

2014 ◽  
Vol 4 (1) ◽  
pp. 68-71
Author(s):  
Yiğit Akin ◽  
Mehmet Sarac ◽  
Isil Basara ◽  
Selcuk Yucel ◽  
Ahmet Kazez
Keyword(s):  
Emergency Department ◽  
Case Report ◽  
Medical Treatment ◽  
Cyst Wall ◽  
Testicular Torsion ◽  
Acute Scrotum ◽  
Scrotal Pain ◽  
Testis Tumor ◽  
Histopathological Evaluation ◽  
History Of

Bilateral epididymal cysts are rare in childhood. Clinically they may present as acute scrotum and should be differentiated from other pathologies. Here in, we report bilateral epididymal cysts in a 14-year-old boy. He was admitted to emergency department with symptoms of acute left scrotum. There was no history of trauma or infection. Blood analyses, including testis tumor markers were unremarkable. Bilateral epididymal cysts were diagnosed on ultrasonography evaluation. Medical treatment did not stop his scrotal pain. During scrotal exploration, there was no evidence of testicular torsion or any other pathology. An excision of cyst was performed. Histopathologically, the cyst wall was lined by columnar epithelia. As a result of these findings, a pathological diagnosis of epididymal cyst was made. The synchronized evaluation of clinical and ultrasonography findings with an appropriate histopathological evaluation can usually diagnose this rare pathology.

The acute scrotum: Frequency and range of etiologies in a Middle Eastern setting

2019 ◽  
Vol 87 (1) ◽  
pp. 15-18 ◽  
Author(s):  
Rami Nasr ◽  
Ziad Tayara ◽  
Ramy Abou Ghayda ◽  
Ibrahim Alsheikh Deeb ◽  
Diamond Ghieh ◽  
...  
Keyword(s):  
Emergency Department ◽  
Confidence Interval ◽  
Medical Center ◽  
Middle Eastern ◽  
Acute Scrotum ◽  
Scrotal Pain ◽  
American University ◽  
American University Of Beirut ◽  
Acute Scrotal Pain ◽  
Study Results

Aim: To investigate the frequency of different etiologies of acute scrotal pain in males presenting to the emergency department at American University of Beirut Medical Center in Beirut, Lebanon. Materials and Methods: In all, 94 patients between the ages 18 and 40 years presenting to the emergency room at American University of Beirut Medical Center with acute scrotum were recruited. The scrotum was inspected with palpation, and Doppler Ultrasound of the testicle was performed by a radiology resident to confirm the diagnosis. The study results were then collected after the official reports were signed by a board-certified radiology attending with expertise in ultrasound. Results: Of the 94 patients presenting with acute scrotal pain, 23.4% (95% confidence interval (0.70–0.87)) had no ultrasound findings and were considered normal. On the other hand, 54.3% (95% confidence interval (0.45–0.66)) were diagnosed with varicocele, 9.6% (95% confidence interval (0.04–0.16)) were diagnosed with epididymo-orchitis, and 9.6% (95% confidence interval (0.04–0.16)) had a history of trauma to the testicle. Patients presenting with acute scrotum had a pain duration of 13.2 ± 4.5 h, with 10.6% (95% confidence interval (0.04–0.17)) having associated urinary symptoms, 18.1% (95% confidence interval (0.09–0.25)) have had sexual activity within 48 h of presentation, and 10.6% (95% confidence interval (0.04–0.17)) were pre-diagnosed with varicocele. Conclusion: Varicocele is the most common cause of acute scrotal pain in patients presenting to American University of Beirut Medical Center in Beirut. This should direct varicocele to the top of our differential when a patient with acute scrotum presents to the emergency department. Nevertheless, ruling out torsion remains the first step in the workup.

scholarly journals Functional testicular torsion secondary to an incarcerated inguinal hernia in a 4-month old: complete recovery at 18-hours

2021 ◽  
Vol 2021 (2) ◽  
Author(s):  
Gregory M Taylor ◽  
Christian C Strachan
Keyword(s):  
Inguinal Hernia ◽  
Testicular Torsion ◽  
Pediatric Patients ◽  
Complete Recovery ◽  
Cord Compression ◽  
Acute Scrotum ◽  
Indirect Inguinal Hernia ◽  
Incarcerated Inguinal Hernia ◽  
Scrotal Swelling ◽  
Urological Emergencies

Abstract One of the most common urological emergencies encountered in pediatric patients in the emergency department (ED) is the acute scrotum. We present the case of a 4-month-old male that presented to our community ED with scrotal swelling and vomiting of 16-hours duration. He was diagnosed with a functional testicular torsion from an incarcerated inguinal hernia, transferred to a hospital with pediatric urological capabilities and was taken to the operating room ~2 hours later. His hospital course was unremarkable, and he was discharged on day 3, having made a full recovery without any loss of bowel or testicle. There have only been a handful of cases in the literature of a pediatric patient presenting with a functional testicular torsion as a result of spermatic cord compression from an indirect inguinal hernia, with no reported cases of complete salvage at nearly 18 hours since symptom onset.

Causes of delayed exploration of the acute scrotum in a regional tertiary centre

2020 ◽  
pp. 205141582098119
Author(s):  
Benjamin Storey ◽  
Nathan Shugg ◽  
Alison Blatt
Keyword(s):  
Retrospective Review ◽  
Testicular Torsion ◽  
Tertiary Hospital ◽  
Adverse Outcomes ◽  
Acute Scrotum ◽  
Tertiary Institution ◽  
Level Of Evidence ◽  
Scrotal Pain ◽  
Surgical Exploration ◽  
Significant Difference

Background: Testicular torsion is an organ-threatening surgical emergency with a limited timeframe for intervention. Objective: To identify the delays to surgical exploration of patients with an acute scrotum in a tertiary hospital to prevent adverse outcomes associated with this time critical emergency. Methods: A retrospective review of medical records for all patients who underwent scrotal exploration for acute scrotal pain in a tertiary hospital in regional New South Wales between January 2008 to December 2018 was performed. Results: Retrospective review identified 242 patients, of whom 161 had testicular torsion and 56 resultant orchidectomies. No statistically significant difference in pre-hospital delays between paediatric or adult populations was found. The average time from presentation to theatre was 4 h 36 min. Patients who were delayed > 6 h from presentation to surgical exploration had significantly increased rates of orchidectomy. Delays that significantly affected rates of orchidectomy were transfer from peripheral sites, late presentation, misdiagnosis and representation after discharge. Conclusion: The most common reason for delay was diagnostic error with the patient later re-presenting to hospital. Patient transfer from the primary hospital to a tertiary institution and subsequent delayed surgical exploration also contributed to significantly higher rates of orchidectomy. Level of Evidence: 3

Acute Testicular Torsion: Presentation and Diagnosis

2019 ◽  
Author(s):  
Claudia Berrondo ◽  
Robert A. Mevorach ◽  
Jimena Cubillos
Keyword(s):  
Testicular Torsion ◽  
Near Infrared ◽  
Color Doppler ◽  
Bimodal Distribution ◽  
Long Term Effects ◽  
Scrotal Pain ◽  
Unique Challenge ◽  
Acute Infarction ◽  
Hormonal Function ◽  
Acute Scrotal Pain

Testicular torsion is the most common pediatric urologic emergency and is a common cause of acute scrotal pain. Timely diagnosis is important for testicular salvage,as treatment delayed beyond 6 hours from the onset of symptoms is the most predictive factor of testicular death. There is a bimodal distribution of age with extravaginal torsion most commonly presenting in the neonatal period and intravaginal torsion most commonly presenting around the onset of puberty. Intermittent testicular torsion presents a unique challenge in making an accurate diagnosis, as patients most often present when asymptomatic. Several risk factors exist, although bell-clapper deformity is the most important. The diagnosis is made largely on history or physical examination. In equivocal cases, imaging with color Doppler ultrasonography may be helpful in making the diagnosis. Additional tools including near-infrared spectroscopy and Testicular Workup for Ischemia and Suspected Torsion score may be helpful in diagnosing testicular torsion. Possible long-term effects on fertility and hormonal function are also often a concern for the patient and clinician. This review contains 6 figures, 5 tables, and 34 references.  Keywords: acute, infarction, ischemia, orchidopexy, scrotum, spermatic cord, testis, torsion

Intermittent Testicular Torsion

PEDIATRICS ◽  
1986 ◽  
Vol 77 (6) ◽  
pp. 908-911
Author(s):  
Thomas J. Stillwell ◽  
Stephen A. Kramer
Keyword(s):  
Primary Care Physicians ◽  
Testicular Torsion ◽  
Separate Entity ◽  
Scrotal Pain ◽  
Young Males ◽  
Testicular Pain ◽  
Acute Scrotal Pain ◽  
History Of ◽  
Scrotal Swelling ◽  
Physical Findings

Testicular torsion is the most common cause of acute scrotal pain in prepubertal and adolescent boys and should be foremost in the minds of primary care physicians evaluating these children. Intermittent testicular torsion is a separate entity that should be considered in all young males with a history of scrotal pain and swelling. Acute and intermittent sharp testicular pain and scrotal swelling, interspersed with long intervals without symptoms, are characteristic. Physical findings may include horizontal or very mobile testes, an anteriorly located epididymis, or bulkiness of the spermatic cord from partial twisting. Awareness of this entity and early elective orchiopexy will improve testicular salvage in patients with intermittent testicular torsion.

Acute scrotal pain from idiopathic ilioinguinal neuropathy: Diagnosis and treatment with EMG-guided nerve block

2007 ◽  
Vol 109 (6) ◽  
pp. 535-537 ◽  
Author(s):  
B.C. ter Meulen ◽  
E.W. Peters ◽  
A. Wijsmuller ◽  
R.F. Kropman ◽  
A. Mosch ◽  
...  
Keyword(s):  
Nerve Block ◽  
Diagnosis And Treatment ◽  
Scrotal Pain ◽  
Acute Scrotal Pain
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