The Acute Scrotum: DR - Dwimantoro Iman P, Spu
The Acute Scrotum: DR - Dwimantoro Iman P, Spu
Bagian Urologi
SMF/Lab.Ilmu Penyakit Bedah FK.UNUSA /
RSI Jemursari Surabaya
THINGS YOU SHOULD KNOW
AS A JUNIOR DOCTOR
There are multiple causes
for acute scrotal pain
and it is often difficult to differentiate them
Causes Trauma
Infection Other
CAUSES
Testicular Referred
Ischaemia Infection Other
Trauma pain
Epididymitis Varicocoele
Torsion of Nerve root
Rupture
testis pain
Epididymo- Hydrocoele
orchitis
Contusion Spermatocoele
Torsion of Retrocaecal
Orchitis or
appendage appendicitis Strangulated
Haematoma inguinal hernia
Fornier’s Heinrech-Scholein
Gangrene purpura (HSP)
Testicular Haematoco Urinary vasculitis
• Urinalisis
• Doppler ultrasound
1. 2.
Diagnosis – “Time is Testicle”
•Ideally prompt clinical diagnosis
•Imaging
•Color doppler – decreased intratesticular flow
• False + in large hydrocele, hematoma
• Sens 69-100% and Spec 77-100%
• Lower sensitivity in low flow pre-pubertal testes
•Nuclear Technetium-99 radioisotope scan
• Show testicular perfusion
• 30 min procedure time
• Sens and spec 97-100%
•Acute torsion L testis
•Dec blood flow on L
•Late torsion on R
•Inc blood flow around
but dec flow w/in
testis
Images - Torsion
• Decreased echogenicity
and size of right testicle
Immediate
exploration
Detorsion
Fixation OR
Orchidectomy
TESTIS/EPIDYDIMIS INFECTION
•Bacterial
• UTI younger/older patients
• usually gram negative bacteria
• STD sexually active patients
• Chlamydia trachomatis
• Neisseria gonorrhoeae
•Viral
• Mumps
INVESTIGATIONS
•Urine cultures
•Urinary STD screen
in sexually active
•Doppler ultrasound Doppler ultrasound
•(Bloods + blood
cultures)
Microscopy of
E. coli
TREATMENT
• Analgaesia & scrotal support
• Urinary tract source (for 14 days) –
empirical
• Trimethoprim 300mg PO daily
• OR cephalexin 500mg PO QID
• OR augmentin 1tab PO BD
• Sexually active young men – empirical
• Ceftriaxone 500mg IV
• AND Azithromycin 1g PO stat
• AND Doxycycline 100mg PO BD (14 days)
• Testicular Rupture
• Requires prompt surgical repair
• Can only be seen on US in 20% - go by clinical suspicion
• Retrocaecal appendicitis
• Urinary stones
• Nerve root pain
OTHER CAUSES
•Varicocoele
•Hydrocoele
•Spermatocoele