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THE ACUTE SCROTUM

THE ACUTE SCROTUM. Urology for Medical Students. THINGS YOU SHOULD KNOW AS A JUNIOR DOCTOR. TOPIC OUTLINE. CAUSES . ANATOMY OF TORSION. Types << Intravaginal twisted spermatic cord within tunica vaginalis Extravaginal >> twisted spermatic cord AND tunica vaginalis (in neonates).

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THE ACUTE SCROTUM

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  1. THE ACUTE SCROTUM Urology for Medical Students

  2. THINGS YOU SHOULD KNOW AS A JUNIOR DOCTOR

  3. TOPIC OUTLINE

  4. CAUSES

  5. ANATOMY OF TORSION • Types • << Intravaginal • twisted spermatic cord within tunica vaginalis • Extravaginal >> • twisted spermatic cord AND tunica vaginalis (in neonates) • Structures • Testis • Appendix epididymis • Appendix testis

  6. RISK FACTORS • Bell-Clapper deformity • Undescended testis Bell-Clapper Deformity (blue is tunica vaginalis)

  7. SURGERY

  8. TESTIS/EPIDYDIMIS INFECTION • Bacterial • UTI  younger/older patients • usually gram negative bacteria • STD  sexually active patients • Chlamydia trachomatis • Neisseria gonorrhoeae • Viral • Mumps

  9. INVESTIGATIONS • Urine cultures • Urinary STD screen in sexually active • Doppler ultrasound • (Bloods + blood cultures) Doppler ultrasound Microscopy of E. coli

  10. 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) • If not improving exclude abscess • Ensure urine clear at end of antibiotics with U/A

  11. FOURNIER’S GANGRENE • Necrotising fasciitis of genitalia & perineum • High mortality (30%) • Rapidly progressing • Risk factors – Diabetic, Immunocompromised, Alcoholic • Treatment • Rapid surgical debridement • Supportive care & broad spectrum antibiotics • Hypobaric oxygen

  12. TRAUMA • Testicular Rupture • Requires prompt surgical repair • Can only be seen on US in 20% - go by clinical suspicion • Testicular Contusion/Intratesticular Haematoma • Hypoechoic or haetrogenous area on ultrasound • Usually explored because rupture cannot be excluded. • Then managed symptomatically: • Analgaesia • Scrotal support & elevation • Ensure resolution on follow-up ultrasound  could be a testicular carcinoma!

  13. REFERRED PAIN • Retrocaecal appendicitis • Urinary stones • Nerve root pain

  14. OTHER CAUSES • Varicocoele • Hydrocoele • Spermatocoele • Strangulated inguinal hernia • Heinrech-Scholein purpura (HSP) vasculitis • Testicular tumour (rapidly growing/necrotic)

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