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Any acute scrotal pain requires immediate surgical assessment for torsion of the testis or strangulated inguinal hernia, which are surgical emergencies. Early surgical consultation is vital, as delay in scrotal exploration and detorsion of a torted testis will result in testicular infarction within 8-12 hours.
Collection of abnormally enlarged spermatic cord veins, found in teenage boys, mostly on the left. Mass of varicose veins ("bag of worms") above testicle, non-tender, more prominent when standing. Surgical evaluation should be undertaken in all testicular trauma, unless the testis clearly can be felt to be normal and without significant tenderness.
Young infants or systemically unwell children with epididymoorchitis should be admitted for i.v.
As I have pointed out, scrotal edema can be due to any number of causes including heart or liver failure, cancer compressing the pelvic veins or lymphatics or even enlargement of the prostate resulting in bladder distention. Scrotal swelling is abnormal enlargement of the scrotum, the sac surrounding the testicles. Considerations Scrotal swelling can occur in males at any age.
The proper treatment will require a full evaluation by your doctor and management of the underlying cause of the edema. Support by soft foam pads can be helpful and provide comfort to the patient while the underlying problems are being treated. The testicles and penis may or may not be involved. Testicular torsion is a serious emergency in which the testicle become twisted in the scrotum and loses its blood supply. Interstitial space is the extravascular compartment of the extracellular fluid and surrounds the cells of a given tissue.
Adolescents with epididymoorchitis should have a first-pass urine sample (ideally first morning urine) for chlamydia and gonococcus PCR. Torsion or twisting of the spermatic cord is the most common etiology of acute scrotum in children. Further reading about basics of fluid compartment and fluid therapy: Basics of fluid therapy. The process is slow to resolve and the patient may have several weeks of gradually subsiding discomfort and scrotal swelling. The combination of a physical exam and history will determine whether you need any tests. Your health care provider may prescribe antibiotics and pain medications, or recommend surgery.


Surgical treatment, within 6 hours of the onset of symptoms, may ensure the preservation of the testis.
For that reason any acute scrotal pain with edema requires urgent and specialized evaluation. Chronic edema of the scrotum can be caused by a number of conditions such as heart failure, liver failure, venous obstruction, lymphatic obstruction or prior surgery or trauma.
For example, patients who have kidney failure and as a result have peritoneal dialysis catheters put in place can develop edema of the scrotum due to drainage from the peritoneal cavity through the inguinal canal and into the scrotum.
In the case of congestive heart failure or liver failure, the problem is that blood flow to the heart or through the liver is impaired.
Joel Gelman, who heads the Center for Reconstructive Urology at the University of California, Irvine, played no role in Warren’s death.“He had been in good spirits after the operation, traveled around in a new van he bought,” Hurtado said. The proper treatment in these cases is the management of the congestive heart failure or the liver failure. In myxedema, there is infiltrative edema with deposition of mucinous materials under the skin.
For example, in the case of congestive heart failure, scrotal edema will often improve when some of the stress on the heart is removed by medications. He had no immediate family in the area.“There are a lot of shows about makeovers, but this is a real makeover,” Gelman told the Review-Journal after he and three other California physicians donated their expertise and cut away simultaneously for 13 hours on the grossly enlarged protective sac of skin and muscles that contained Warren’s testicles and penis.
Edema of the scrotum can also occur due to compression of the veins in the pelvis or abdomen. For example, cancers such as prostate cancer or lymphoma can grow and put pressure on the veins or lymphatics and cause edema.
He wore a hoodie upside down to cover his scrotum, using a safety pin and belt to hold the sweatshirt up.At home, Warren often sat in the living room of his near downtown apartment with his scrotum atop a milk crate as he watched TV. In this case, the proper treatment is control of the cancer so that the pressure exerted on the veins and lymphatics is relieved. Because his penis was buried deep inside his scrotum, he was unable to control his urination. I have had many cases of severe edema of the scrotum that have resolved after effective treatment of the cancer that was putting pressure on the veins or lymphatics. He frequently sprinkled the scrotum with baby powder to kill the smell of urine.Much like Victorian England’s Joseph Merrick, whose life with severe deformities became the subject of both the play and movie, “The Elephant Man,” Warren concluded in 2011 that to escape his life of “hell” he had to allow himself to be exhibited.


In some cases prostate cancer or non-cancerous enlargement of the prostate can make urination difficult, resulting in the retention of urine in the bladder.
If the bladder gets large enough, it can cause compression of the pelvic veins resulting in bilateral lower extremity and scrotal edema. Learning is not memorizing but conceptualizing.Epomedicine also provides quick access to case discussion on interesting medical cases, videos for developing correct clinical skills and a blog to go beyond notes and research articles to explore the inner-self of medical students and healthcare professionals. These patients improve dramatically when the excess urine in the bladder is removed and the enlarged prostate is treated by surgical reduction.
Since edema of the scrotum often occurs due to a blockage at the level of either the heart or the liver or the draining lymphatics or veins, application of compression of the scrotum will not fix the underlying problem and may result in worse edema. The scrotum has a limited blood supply and compression of the scrotum could further diminish that blood supply.
However, I do not know of any approved devices for compression of the scrotum to treat scrotal edema. Doctors said a common cause of some enlargement, a hernia and fluid accumulation between the testicle and skin, could not have done it.
I am including a figure of the anatomy of the blood flow to the testicles to make my point.
He also did not travel to Africa, Asia Central American or South American where a mosquito-spread parasitic infection causes the condition. Las Vegas surgeon Kassahun has discounted Warren’s theory that bumping his testicles in bed in 2008 with his own leg caused the problem.Living on disability and unable to work, Warren said he hoped what he called his “freak show” could earn him money.
He signed a contract with a British company that filmed his struggles with his condition and his subsequent operation.Firecracker Films’ documentary, called “The Man with the 10-Stone Testicles,” was a ratings hit in Great Britian, with nearly 4 million viewers.
Compression of an edematous scrotum may further diminish venous outflow potentially worsening the condition. In addition, the skin of the scrotum is very thin and compression could lead to skin breakdown.



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