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Five GU emergencies
Testicular torsion, Fournier's gangrene,
paraphimosis, priapism, and significant GU trauma
Related emergencies include
strangulated inguinal hernia and ruptured abdominal aortic aneurysm
The testes average in size between 4 - 5 cm in length
and 3 cm in width and depth and usually lie in an upright position
外傷 Trauma
r/o testicular rupture
r/o testicular rupture
Testicular torsion 睪丸扭轉
常見於 15-25 y/o (新生兒和青春期後)
Sudden onset, Cramping pain, Testis axis 改變 (Transverse lie)
Negative Prehn's sign ( no lifting sign ) : 睪丸上提無法緩解疼痛
TWIST score : 腫 硬 吐 高位 沒反射 !!
> 12小時常造成不可逆傷害，甚至導致不孕
儘管手動解旋帶來改善, 還是要做手術探查, 並將睪丸固定
Torsion of the appendix testis 睪丸附件扭轉
大部分的睪丸附件扭轉發生於 9-11 歲
是兒童時期最常見的陰囊疼痛成因，在成人很少見
相對於睪丸扭轉，附件扭轉的進展相對比較慢
(可能是忍了數天後才來醫院求診)
PE：可能出現 Reactive hydrocele, 壓痛
診斷：PE, 超音波 (Doppler 睪丸的血流正常)
治療 ：保守治療
手術治療 ：切除睪丸附件 (只在疼痛持續的病患)
Infection : Epididymo - Orchitis 睪丸副睪炎
成人陰囊疼痛最常見的原因
Fever, Gradual pain, 紅腫熱痛, UTI
Prehn's sign : 抬高 testis 較不痛
急性 (< 6周) / 慢性 (> 6周)
菌種 Shoulde cover Gonorrhea and Chlamydia
1. < 35 y/o -- STD : Chlamydia trachomatis, N. gonorrhea
2. > 35 y/o --BPH related, E. Coli, Pseudomonas, Klebsiella
3. HIV : CMV, Cryptococcus 也可能造成
Recent studies suggest sexually transmitted infections associated with epididymitis
occur in all sexually active age groups.
Scrotal abscess 睪丸膿瘍
Management of a scrotal abscess depends on its depth
A simple hair follicle scrotal wall abscess
is managed by incision and drainage.
If abscess of deeper structures cannot be ruled out clinically or with US,
consult urology for definitive management.
Antibiotics are rarely needed in an immunocompetent male
unless there are signs of cellulitis or systemic involvement.
Orchitis 睪丸炎
Rare
Mumps or other viral illnesses
(coxsackie virus, Epstein-Barr virus, varicella, or echovirus).
Orchitis in immunocompromised patients
can be due to mycobacteriosis, cryptococcosis, toxoplasmosis, or candidiasis.
Fournier's gangrene
會陰部壞死性筋膜炎
通常會侵犯到陰囊
皮下出現氣體, 水泡, crepitus and ecchymosis, 發燒, Septic shock
benign infection or simple abscess that quickly becomes virulent,
especially in an immunocompromised host,
and results in microthrombosis of the small subcutaneous vessels,
leading to the development of gangrene of the overlying skin
菌種：混合感染 (有氧 + 厭氧菌)
可以靠超音波, CT 協助判斷
早期積極的清創
給予適當的抗生素治療
支持性治療
Aggressive fluid resuscitation
Recommended agents include piperacillin-tazobactam
3.375 to 4.5 g IV Q6H,
or imipenem, 1g IV QD, or meropenem, 500 mg to 1 g IV Q8H,
plus vancomycin
The addition of clindamycin, 600 - 900 mg IV Q8H, or metronidazole
1g IV, then 500 mg IV Q8H,
to the antimicrobial regimen may be of benefit.
Radiation pain
AAA, 結石, 腰椎狹窄, 後腹腔腫瘤
Tumor
大多以無痛性腫塊表現
若是快速變大的 Germ cell tumor
可能會因出血梗塞導致陰囊疼痛
Ten percent of tumors will present with pain secondary to acute hemorrhage within the tumor
Hernia
Varicocele
久做久站惡化, dullness pain, progressive pain
Muscle strain
Neuralgia
Henoch-Schonlein purpura (IgA vasculitis)
Mumps
http://www.thetinynote.com/topic/44/day401_%E6%88%90%E4%BA%BA%E6%80%A5%E6%80%A7%E9%99%B0%E5%9B%8A%E7%96%BC%E7%97%9B%E7%9A%84%E8%A9%95%E4%BC%B0
- Testicular torsion : Prehn's sign - (上提睪丸無法緩解疼痛 )
- Epididymo - orchitis : Prehn's sign + (上提睪丸會緩解疼痛)
Scrotal edema
Insect bites and contact dermatitis may cause scrotal edema,
or it may be idiopathic.
In the setting of hypoalbuminemia,
or anasarca from any cause, contiguous scrotal and penile edema may occur.
Idiopathic scrotal edema presents as unilateral or bilateral mild pain with scrotal,
perineal, and inguinal swelling and erythema,
most commonly in boys between 5 - 8 years of age.
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