Scrotal Abnormalities

Question 1

True/false
Scrotal Trauma
The mobility of the testicle, cremasteric muscle and the tough capsule of the testis are responsible for the infrequent rate of injury to the testis.

Answer 1

true

Question 2

True/false
For all patients with blunt or penetrating trauma, evaluate Scrotal Trauma before airway breathing, circulation and disability during the primary survey per advanced trauma life support protocol

Answer 2

FALSE
ABCD first

Question 3

Scrotal skin avulsion/laceration
1) Should be explored and debrided.
2) Managed by housing the testicle in the ______ even if the repair may place the skin under tension

Answer 3

remaining scrotal skin

Question 4

What usually occurs secondary to a direct blow to the testis impinging against the pubic symphysis (i.e. bicycle injury).

Answer 4

Blunt testicular injury

Question 5

Laboratory considerations for scrotal trauma

Answer 5

(a) CBC (looking for anemia or infection)
(b) UA (looking for hematuria)

Question 6

Imaging considerations for scrotal trauma

Answer 6

Scrotal and testicular ultrasound

Question 7

Imaging
______ studies can help delineate extent of testicular involvement and evaluate for testicular rupture.

Answer 7

Colored Doppler

Question 8

True/False
Blunt and penetrating testicular injuries do not require MEDEVAC to urology

Answer 8

False
does require MEDEVAC
For exploration, evacuation of blood clots and repair of testicular rupture

Question 9

True/False
Lacerations or avulsions just involving the skin can be closed primarily by independent provider.

Answer 9

True

Question 10

Complications for scrotal trauma

Answer 10

(a) Hematoma infection
(b) Testicular atrophy
(c) Fournier’s gangrene

Question 11

What is necrotizing fasciitis (polymicrobial infection) of the subcutaneous tissue of the perineum often involving the scrotum

Answer 11

Fournier’s Gangrene

Question 12

Must maintain a high suspicion for Fournier’s when patients presenting with what?

Answer 12

scrotal, rectal or any genitalia pain out of proportion to their physical exam findings.

Question 13

Signs and symptoms of what issue
(a) Tense edema of scrotum and other involved skin
(b) Blisters/bullae
(c) Crepitus
(d) Fever
(e) Pain (out of proportion to physical exam)
(f) Tachycardia
(g) Hypotension

Answer 13

Fournier’s Gangrene

Question 14

Imaging for Fournier’s Gangrene

Answer 14

Computed tomography (CT) and magnetic resonance imaging (MRI)
-May show air along the fascial planes or deeper tissue involvement

Question 15

True/False
Fournier’s Gangrene
Imaging should be obtained prior to surgical exploration when there is clinical evidence of progressive soft tissue infection.

Answer 15

FALSE
Imaging studies should not delay surgical exploration when there is clinical evidence of progressive soft tissue infection

Question 16

Fournier’s Gangrene Tx

Answer 16

(a) Aggressive surgical exploration and debridement
(b) Broad spectrum antibiotics
—Ertapenem
(c) Fluid resuscitation
(d) MEDEVAC

Question 17

Fournier’s Gangrene Complications
Patients may ultimately require:

Answer 17

1) Cystostomy
2) Colostomy
3) Orchiectomy

Question 18

Fournier’s Gangrene
_______ consultation is often required when periurethral abscess is the inciting event or if the gangrene has invaded the urinary tract.

Answer 18

Urologic

Question 19

A tense hydrocele or firm spermatocele must be differentiated from what?

Answer 19

tumor

Question 20

Conditions causing painless scrotal swelling are not true emergencies unless what?

Answer 20

testicular tumors are discovered
which are life threatening and require urgent evaluation (within a few days).

Question 21

What issue?
Dilation of the pampiniform plexus of spermatic veins and is generally left sided
1) Usually asymptomatic mass; some patients have mild pain.
2) Mass is separate from testis;
3) Feels like “bag of worms,” especially in upright position.
4) Size increased by Valsalva maneuver.
5) Right-sided varicocele should raise suspicion for inferior vena cava and intraabdominal pathology.
6) Sudden left-sided varicocele should raise suspicion for left renal vein obstruction, or renal tumor.

Answer 21

Varicocele

Question 22

S/s of what issue?
Collection of peritoneal fluid between the parietal and visceral layers around the testes and spermatic cord.
1) Gradually enlarging painless cystic mass that transilluminates
2) May indicate tumor

Answer 22

Hydrocele

Question 23

S/S of what issue?
Fluid filled cyst at the head of the epididymis that may contain
nonviable sperm.
1) Painless
2) Palpated as distinct from the testis
3) Typically transilluminates as cystic in nature

Answer 23

Spermatocele

Question 24

What is the diagnostic imaging of choice for scrotal and testicular abnormalities

Answer 24

Ultrasound

Question 25

Patients with newly diagnosed testicular enlargement or mass lesions should be urgently referred to where?

Answer 25

Urologist

Question 26

True/False
Malignancy is often very painful

Answer 26

False
often painless