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PubMed2001

Value of acute-phase proteins in the differential diagnosis of acute scrotum.

OBJECTIVES: The evaluation of patients with an acute scrotum is primarily based on physical examination, imaging studies, as well as blood and urine tests. However, the differential diagnosis may be difficult in some cases. In a retrospective study, we investigated the value of acutephase proteins in serum and plasma from patients with an acute scrotum. METHODS: A total of 104 patients (epididymitis n=52, testicular tumor n=17, testicular torsion n = 11, other conditions n = 24) with an acute scrotum were included in this study. In all patients the acute-phase proteins C-reactive protein (CRP), haptoglobin, alpha1-acid glycoprotein and transferrin in serum as well as fibrinogen in plasma were determined by turbidimetric analysis. The results were compared to the clinical findings, routine blood and urine tests and ultrasound. RESULTS: Patients with an epididymitis showed at least a 4-fold elevation of CRP except for 2 cases (median 63.2 mg/l). In these patients, the sensitivity of CRP was 96.2%, the specificity 94.2%, the negative predictive value 94.2% and the positive predictive value 94.3%. Patients with a testicular tumor had no significant elevation of CRP (median 9 mg/l) as well as those with a testicular torsion (median 5 mg/l) except for 1 patient. The difference between patients with epididymitis and those with noninflammatory conditions was statistically significant (p<0.001, Kruskal-Wallis test and Tukey-Kramer test). The remaining parameters (haptoglobin, fibrinogen, a1-acid glycoprotein, transferrin, white blood count, body temperature and ultrasound) were less sensitive and specific. CONCLUSIONS: Acute-phase proteins (especially C-reactive protein) are helpful in differentiating epididymitis from noninflammatory conditions like testicular torsion or tumor. Turbidimetric analysis of these proteins is rapid, easy and inexpensive.

Acute Disease↗
PubMed1994

Color Doppler sonography of the scrotum in children.

Color Doppler sonography is a well-accepted method for evaluating abnormalities of the scrotum and testes in children. The use of color Doppler sonography is especially important in acute diseases, allowing the evaluation of both perfusion and morphology. Most previous reports of the use of color Doppler sonography in the scrotum have been in adults [1-4]. In this pictorial essay, we illustrate normal and abnormal findings on color Doppler sonograms of the scrotum in children, particularly in prepubertal patients. Experience with vascular anatomy, inflammatory processes, testicular torsion, and tumors is emphasized.

Adolescent↗
PubMed1999

[Sclerosing lipogranuloma of the scrotum: a case report].

We present a case of sclerosing lipogranuloma of the scrotum. A 42-year-old man who had complained of a painless intrascrotal mass of one week's duration visited our clinic. Physical examination revealed a symmetrical Y-shaped hard mass around the penile base in the scrotum. Laboratory examination showed no abnormal findings except for a 14.0% eosinophilia. Magnetic resonance imaging (MRI) with a surface coil showed an atypical mass at the penile base. Percutaneous needle biopsy under ultrasound guidance was performed and histopathological findings revealed lipogranuloma accompanied by infiltrating multinuclear giant cells, eosinocytes and lymphocytes. The tumor gradually disappeared during a 4-week administration of antibiotics and antiphlogistics. We have also reviewed 95 cases of sclerosing lipogranuloma of the scrotum in the Japanese literature.

Adult↗
PubMedDate not supplied

Mesh plug migration into scrotum: a new complication of hernia repair.

Hernia repair is one of the most frequent operative procedures performed throughout the world. The technique has continued to evolve and we now are performing these repairs utilizing mesh as a patch and also as a plug. The mesh plug concept has been advocated by Rutkow and others. With this change in technique, we have seen a new complication of hernia repair - the migration of the mesh plug from the original hernia repair site into the scrotum. It presented as a large tender mass in the scrotum of a 45-year-old male who had had previous recurrent surgery. In addition, he again had a recurrent incarcerated hernia. Correction of the hernia and resection of the migrated mesh plug from the scrotum were carried out. It is recommended that both the patch and the plug be into position to avoid or reduce the risk of such a recurrence and plug migration.

Foreign-Body Migration↗
PubMed1999

[Fournier's gangrene involving all of the scrotum: treatment by multiple repeated surgical excisions, diversion colostomy, triple antibiotic therapy and postoperative intensive care].

OBJECTIVES: To describe and analyse the proposed therapeutic modalities to treat a series of patients suffering from Fournier's gangrene involving the entire scrotum. MATERIAL AND METHODS: Four patients with macroscopically identical lesions of Fournier's gangrene involving the entire scrotum were managed by wide surgical debridement, diversion colostomy, triple combination antibiotic therapy, transfer to surgical intensive care, multiple repeated operations under general anaesthesia for excision of atonic tissues and mesh skin grafts. The colostomy was closed after 4 months. RESULTS: All patients survived after skin cover. Three of them were reviewed 2 months after restoration of gastrointestinal continuity and presented a good general status with a satisfactory esthetic result. The fourth patient was lost to follow-up. The mean reoperation rate was 6.5 per patient. The mean intensive care stay was 9.5 weeks. CONCLUSION: The choice of intensive treatment depends on the extent of the lesions. When the entire scrotum is involved, repeated surgical excisions and systematic colostomy, combined with the other treatment modalities appear to be necessary to manage this disease, which still has a serious prognosis.

Adult↗
PubMed2000

Orchiopexy using 2 mm. laparoscopic instruments: 2 techniques for delivering the testis into the scrotum.

PURPOSE: We describe modified techniques of laparoscopic orchiopexy using 2 mm. instruments that enable straightforward delivery of the testis into the scrotum. MATERIALS AND METHODS: The preferred technique involves a radially dilating trocar advanced over the 2 mm. grasper placed antegrade through the new internal ring. The other method is similar but Amplatz dilators are used when a radially dilating trocar system is not available. RESULTS: We used these techniques with complete success to deliver 18 testes into the scrotum. CONCLUSIONS: The testis may be safely and effectively delivered to the scrotum using 2 mm. instruments and disposable fascial dilators or a radially dilating trocar system.

Child, Preschool↗
PubMed2000

[Leiomyosarcoma of the scrotum: a case report].

Leiomyosarcoma of the scrotum is a rare tumor. Up to 1999, only 29 cases have been reported in the literature worldwide. A 27-year-old man presented with a mass on the left side of the scrotum which had been painless and had gradually enlarged over the previous 10 years. During the following 3 months, however, it became painful and he was then referred to our hospital. Physical examination revealed a solid mass on the left side of the scrotum, measuring 7 cm in diameter, which was not adhering to the testis or to the vas deferens. The tumor was surgically resected. The histological examination confirmed the diagnosis of well differentiated leiomyosarcoma. Adjuvant therapy was considered unnecessary. The follow-up at 41 months revealed no local recurrence or distant metastasis.

Adult↗
PubMed2000

[Epidermoid carcinoma of the scrotum].

OBJECTIVE: To analyze the therapeutic approach in epidermoid or squamous cell carcinoma of the scrotum, a rare tumor that is of interest for clinical and historical reasons. METHODS/RESULTS: A case of epidermoid carcinoma of the scrotum is described. The patient had undergone urethroplasty in 1972, using preputial free graft, according to the technique of Ben Johnson. Right scrotectomy and orchidectomy were performed and partial urethrectomy with inguinal lymphadenectomy 6 weeks later. At 24 months' follow-up, the patient has no tumor recurrence. CONCLUSION: Malignant tumors of the scrotum are rare. Squamous cell carcinoma is the most frequent tumor type. Radical surgery with inguinal lymphadenectomy is the treatment of choice. It must be distinguished from verrucous carcinoma, a tumor that requires a different therapeutic approach and for which radical surgery is not indicated.

Carcinoma, Squamous Cell↗
PubMed2001

[A case of fibrous pseudotumor in the scrotum].

A 65-year-old man presented with a complaint of the swelling of his right scrotum. Ultrasonogram indicated a tumor in the right scrotum, but it was not apparent whether the tumor arose from the right testis or not. Right high orchiectomy was performed due to the suspicion of malignancy. The tumor arose from the right epididymis and spermatic cord. Histological examination revealed that the tumor was a fibrous pseudotumor in the scrotum.

Aged↗
PubMed2003

[Juvenile gangrenous vasculitis of the scrotum].

OBJECTIVE: To describe clinical and pathological findings of a new case of juvenile gangrenous vasculitis of the scrotum, a peculiar and unusual (only 7 cases, approximately, have been previously reported) type of scrotal gangrene described by Piñol in 1973. METHODS: A 24 year-old male presented at the emergency room with a right scrotal necrotising cutaneous lesion and fever. Physical examination, complete blood count, biochemical test, roentgenographic abdominal and thoracic findings, microbiological test and biopsy were performed. RESULTS: Clinical aspects (symptoms and sings) and results of complete blood count (leukocytosis), normal ultrasound exploration and biochemical and roentgenographic abdominothoracic findings, microbiological test (negative) and biopsy (necrotising vasculitis) are compatible with juvenile gangrenous vasculitis of the scrotum. CONCLUSIONS: Juvenile gangrenous vasculitis of the scrotum is a rare entity which should be diagnosed by strict clinicopathological diagnostic criteria because treatment and prognosis are distinct of other numerous ulcerative scrotal diseases.

Adult↗
PubMed1992

Incomplete prepenile scrotum: report of two cases and review of literature.

An incomplete prepenile scrotum is an unusual anomaly. Two cases of incomplete prepenile scrotum are presented here, both of which are associated with a small phallus, hypospadias and a bifid scrotum. No sex chromosome disorder or hereditary factors contribute to such a disorder. Early surgical correction is recommended.

Child↗
PubMed1992

[One-stage operation for treatment of transposition of penis and scrotum complicated by hypospadia].

Transposition of penis and scrotum is often complicated by hypospadia and used to be corrected by staged operation. Since 1984 a new procedure has been developed in which the transposition of penis and scrotum and clubbed penis were corrected, and urethroplasty was performed at same time. Six children received this operation uneventfully. Postoperative follow-up revealed that normal penis position, erection and urination were achieved in these patients. This operation is applicable to patients with transposition of penis and scrotum complicated by various hypospadia. The operative method and key to ensure success are described in this article.

Child↗
PubMed1992

Squamous-cell carcinoma of the scrotum.

Squamous-cell carcinoma of the scrotum has a poor prognosis unless locally confined. Patients with stage A1 disease have approximately a 75% or better chance for long-term survival. Occupation-related and -induced scrotal carcinomas are less frequent now because of better hygiene, protective clothing, and awareness of the carcinogenicity of industrial oils. A rise in the incidence of the disease might result from the HPV epidemic. The basic treatment of squamous-cell carcinomas of the scrotum still depends on wide local excision of the primary lesion. Patients should be treated with a broad-spectrum antibiotic for 4 to 6 weeks prior to sentinel node biopsy or ilioinguinal lymphadenectomy. Sentinel node biopsy should be performed to rule out micrometastasis and to establish the need for a formal ilioinguinal lymphadenectomy. Radiation therapy has little therapeutic benefit in the management of squamous-cell carcinoma of the scrotum. Bleomycin might be useful as adjuvant therapy for widespread ilioinguinal disease before attempted resection, although this has yet to be proved.

Carcinoma, Squamous Cell↗
PubMedDate not supplied

The acute scrotum: aetiology, management and early outcome-preliminary report.

BACKGROUND: Most patients with acute scrotal pain may require urgent exploration. We determined the aetiological factors, treatment and early complications in such patients. METHODS: This was a prospective study of consecutive patients presenting with the acute scrotum at Jos University Teaching Hospital, Nigeria from January 2001 to December 2002. RESULTS: Twenty-nine patients were studied with a mean age of 29.4 years (range 12 days to 80 years). Seventeen (58.6%) were 11 to 30 years old. The clinical diagnostic accuracy for testicular torsion was 75% because out of the 24 patients initially thought to have testicular torsion, 18 (62.1%), four (14.8%) and two (6.9%) had testicular torsion, epididymoorchitis and torsion of appendix testis respectively at exploration. The diagnosis in other patients was intrascrotral abscess in two (6.9%), Fournier's gangrene in one (3.4%) and haematocoele in one (3.4%). Only four (13.9%) patients presented within the first 24 hours of illness (all explored within 6 hours) and 14 (48.3%) in one to five days. Thirteen (44.6%) patients had orchidopexy while seven (24.2%) had orchidectomy as a result of testicular torsion (five) and intrascrotal abscesses (two). Testicular exploration only, with antibiotics was the treatment for patients eventually found to have epididymoorchitis, with good response. Testicular salvage rate was 72% in patients with testicular torsion. Postoperative complications observed in three patients were wound infection (two) and wound dehiscence (two). CONCLUSION: We conclude that testicular torsion is the most common cause of acute scrotum in our environment. Majority of our patients with acute scrotum present to hospital late. Health education of the public and attending physicians is required in order to reduce delay in presentation, improve diagnostic skills, testicular salvage rate and prognosis.

Acute Disease↗
PubMed2006

[A case of leiomyosarcoma of the scrotum: chemotherapy with anti-cancer agents was effective for the lung metastasis].

A 59-year-old male was referred to our hospital with the chief complaint of a painless scrotal mass. A 6 X 4.5 X 4 cm elastic hard mass with irregular surface was palpable in the right scrotum. We diagnosed a tumor in the right scrotum and resected the tumor surgically. Histopathologically, the tumor was liposarcoma of the right scrotum. Lung tumors were found 20 months after resection of the origin. Systemic chemotherapy with new anti-cancer agents (Paclitaxel and Gemcitabine) was performed. The main tumor was reduced to 56% in its diameter after 6 courses of chemotherapy. Exclusion of the right middle and lower pulmonary lobe was performed. The final pathological diagnosis of the lung tumor was metastatic liposarcoma.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1991

[Duplex echography in acute scrotum. Diagnostic possibilities].

Acute scrotum is a frequent reason for consultation at the urological emergency service. The most common causes, apart from trauma, are acute orchiepididymitis, torsion of the hydatids of Morgagni and torsion of the spermatic cord. Apart from a detailed examination of patient history and a careful physical examination, few diagnostic techniques can be utilized. To date, only the Doppler ultrasound has proved useful in corroborating the suspicion of vascular involvement, although this technique is very limited. With the availability of the duplex ultrasound, the possibility of making the differential diagnosis in the acute scrotum is enhanced. This technique permits morphological and functional assessment and avoids unnecessary exploration surgery within the scrotum.

Acute Disease↗
PubMed1990

Total reconstruction of a two-compartment scrotum by tissue expansion.

A case report is presented showing the reconstruction of a two-compartment scrotum out of hair-bearing perineal skin following a severe degloving injury of the scrotum and testicles. We feel that this is an appropriate procedure to be used in patients who have lost the testicles and scrotum traumatically, either one or both testicles, or in the situation where both testicles have been spared. Aesthetically, the result in this patient is superior to skin grafting and should be readily reproducible.

Adult↗
PubMed1990

[A recurrent gastric carcinoma found by metastasis to the scrotum].

Reported is a case of 67-year-old man with a recurrent gastric carcinoma that was associated with a possible lymphatic metastasis to the scrotum. Seven years earlier (October, 1980), since an adenocarcinoma of the stomach was present, a subtotal gastrectomy was performed. At that time, a IIc-like advanced tumor with a ul-III, measuring 32 x 28 mm in size, was noted on the anterior wall of the corpus near the greater curvature of the stomach, on macroscopical examination of the resected specimen. Microscopic findings showed a poorly differentiated adenocarcinoma with an involvement of the serosa but without a lymph node metastasis (H0, P0, n0, se, stage III). In July 1987, a tumor in the right scrotum was found and the patient underwent surgery. The resected specimen revealed a histologically cancerous involvement of the testis, the epididymis, the tunica vaginalis testis, and the spermatic cord. The cancerous cells showed the same poorly differentiated adenocarcinoma which had been observed in the primary locus of the stomach. Judging from these findings, this case was diagnosed as a recurrent gastric carcinoma with a lymphatic metastasis to the scrotum.

Adenocarcinoma↗