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Scrotal Pain

December 17, 2010 Welcome Applicants!. Scrotal Pain. Testicular Anatomy . Testicular Torsion. Classic Presentation. Sudden onset of severe unilateral pain may radiate to inguinal area or lower abdomen +/- Nausea and vomiting (90%) Consider as secondary event

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Scrotal Pain

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  1. December 17, 2010 Welcome Applicants! Scrotal Pain

  2. Testicular Anatomy

  3. Testicular Torsion

  4. Classic Presentation Sudden onset of severe unilateral pain may radiate to inguinal area or lower abdomen +/- Nausea and vomiting (90%) Consider as secondary event Has been reported post-orchiopexy

  5. “Golden” window • 4 to 8hrs • 12hrs 20% viable • 24hrs nonviable • Consult urology immediately!!

  6. Testicular Torsion: Management • Orchiopexy: surgical detorsion and fixation of both testes • Orchiectomy is performed if the testicle is nonviable

  7. Testicular Torsion: Management • Manual Detorsion: “Open Book” rotation • Medial to lateral • Give appropriate sedation and analgesia • Still need surgical exploration after manual detorsion

  8. Imaging • Not necessary if strong clinical suspicion • Doppler U/S (69-100% sensitive, 77-100% specific) • Nuclear Scan measuring testicular perfusion (100% sensitive, 97% specific)

  9. Torsion of Appendix Testis or Appendix Epididymis

  10. Epididymitis • Most commonly caused by infection • Sexually Active Males: CT is #1, followed by GC, E.Coli, and viruses • Less Common: Ureaplasma, Mycobacterium, CMV, Cryptococcus in HIV+ • Pre-adolescents • Infectious: Mycoplasma, Enteroviruses, Adenoviruses • Non-infectious: may be caused by “chemical inflammation” from reflux of sterile urine

  11. Epididymitis • Risk Factors • Structural abnormalities • Sexual activity • Age • Heavy physical exertion • Bicycle/Motorcycle riding

  12. Epididymitis • UA and UCx should be obtained • Restrospective study: only 15% of patients with Epididymitis had a positive UA • UCx is often negative

  13. Sexually Active Males • When GC/CT suspected: • Ceftriaxone 250mg IM x 1 + Doxycycline 100mg PO BID x 14 days • Quinolones no longer recommended • For Enteric Organisms: • Levofloxacin 500mg PO Qday x 10 days • Ofloxacin 300mg PO BID x 10 days

  14. Pre-Pubertal Boys Bacterial Causes (if they have associated UTI): Bactrim or Cephalexin Non-Bacterial Causes: Supportive Measures (NSAIDs, Bed Rest, Scrotal Support, possibly Abx)

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