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Flashcards in Urologic Emergencies Deck (93)
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1

Differential Diagnosis of Acute Scrotal Pain

Testicular torsion
Appendiceal torsion
Epididymitis
Testicular rupture

2

History of Acute Scrotal Pain

Good pain history
Fever/chills
Dysuria/hematuria
Discharge
H/O trauma

3

Describe a Positive Prehn's Sign

Lifting of testicle on affected side relieves pain

4

Physical Exam Inclusions

Abdominal exam
Exam of testes, epididymis, cord, and scrotal skin
Exam of inguinal region
Cremasteric reflex
Possible DRE to check prostate

5

Work Up of Acute Scrotal Pain

UA and culture
Color doppler ultrasound

6

History of Testicular Torsion

Sudden onset
Possible inciting event or occur spontaneously

7

Symptoms of Testicular Torsion

Lower abdominal pain, inguinal canal or testes
N/V (+/-)

8

Physical Exam Findings for Testicular Torsion

High-riding testis on affected side
Significant swelling
Epididymis may be displaced and not found in normal position
Testicle is firm
Exquisite tenderness
Cremasteric reflex absent

9

Diagnostic Evaluation of Testicular Torsion

Color doppler US of testicle

10

Treatment of Testicular Torsion

Emergent urologic consultation
Manual detorsion
Orchiopexy

11

Describe Manual Detorsion

Twist laterally "like opening a book"
May need to twist 720 degrees

12

Acute Epididymitis

Less than 6 weeks
Swelling of epididymis with exquisite tenderness
+/- inguinal lymphadenopathy
Systemic symptoms: fever/chills, irritative voiding symptoms
+/- acute prostatitis

13

Chronic Epididymitis

6+ weeks
Subtle epididymal induration and tenderness
No irritative voiding symptoms
+/- inguinal lymphadenopathy

14

Physical Exam Findings in Epididymitis

Tenderness posterior and lateral to the testis
DRE to evaluate prostate
Acute: reactive hydrocele
Positive Prehn's sign

15

Work Up of Epididymitis

UA and urine culture
+/- GC and chlamydia
Urethral swab if discharge present
Rule out other causes of scrotal pain

16

Etiology of Epididymitis in Men Younger than 35 Years Old

Gonococcal
Clamydia

17

Treatment of Epididymitis in Men Younger than 35 Years Old

Ceftriaxone 250 mg IM +
Doxycycline 100 mg BID x 10 days

18

Etiology of Older Men or History of BPH, Urethral Stricture, or Chronic UTI

Enteric gram negative bacteria

19

Treatment of Older Men or History of BPH, Urethral Stricture, or Chronic UTI

Levaquin 500 mg QD x 10 days

20

Symptomatic Treatment of Epididymitis

NSAIDs
Scrotal elevation
Ice

21

Risk Factors for Inflammatory Epididymitis

Medication reaction
Prolonged sitting
Vigorous exercise
Trauma
Autoimmune disease

22

Presentation of Inflammatory Epididymitis

Progressive, gradual onset of pain

23

Treatment of Inflammatory Epididymitis

Scrotal elevation
Warm baths
NSAIDs

24

Define Appendix Testis

Small appendage of normal tissue that is usually located on the upper portion of the testis

25

Symptoms of Appendiceal Testis

Gradual onset of pain
Reactive hydrocele (transilluminate)
Localized tenderness
Classic "blue dot" sign

26

Diagnosis of Appendiceal Testis

US shows tossed appendage as a lesion of low echogenicity with central hypoechogenic area

27

Conservative Treatment of Appendiceal Testis

Rest
Ice
NSAIDs
Slow recovery with discomfort
Infarcted tissue usually reabsorbed

28

Surgical Treatment of Appendiceal Testis

Excision of appendix testis

29

Define Testis Rupture

Rip or tear in the tunica albuginea resulting in extrusion of testicular contents

30

Main Symptoms of Testis Rupture

Scrotal swelling
Severe pain
Ecchymosis