Download to read offline
chronic scrotal pain.pptx
- 1. Overview of Chronic ScrotalPain Hassan Almarzooq
- 2. Why This Topic? •Limitations to daily activities. • Limited ability to work and sexual dysfunction. • Psychological disorders, depression, somatization disorder. • Social isolation. • Decreased quality of life.
- 3. Definition • intermittent orconstant, unilateral or bilateral • localized to the scrotal structures • 3 months or longer in duration • significantly interferes with daily activities • and prompts the patient to seek medical attention.
- 4. ETIOLOGY • 50% ofpatients will not have an identifiable etiology. • “self-palpation” orchitis. • Psychological.
- 5. Varicocele • Dilatation ofthe pampiniform plexus of spermatic vein. • Clinical features: • Asymptomatic. • Dull, aching, scrotal pain. standing Vs recumbency position. • Scrotal fullness. • Large, soft, left-sided? scrotal mass ( bag of worm). • Infertility. • Alarming features: • Unilateral right varicoceles. (IVC) • Non-diminishing.
- 6.
- 7. Hydrocele • collection ofperitoneal fluid between the parietal and visceral layers of the tunica vaginalis. • Idiopathic Vs Reactive. • Clinical features: • Painless swelling. • Heaviness. • Pain (correlate with size). • Transilluminates. • Treat: symptomatic, skin integrity is compromised. • Management: • excision of the hydrocele, Simple aspiration?
- 8. Epididymal cyst/Spermatocele • Roundsoft mass in the head of the epididymis. • Main differential: epididymal cystadenoma or, rarely, cystadenocarcinoma Examination: as a “cluster of grapes”. US • Clinical features: • Painless swelling. • Heaviness. • Pain (correlate with size). • Transilluminates. • Surgical excision. If chronic pain.
- 9. Testicular cancer • Painless,firm, nontender nodule or mass that does not transilluminate. • +- gynecomastia, elevated Beta- hCG • Scrotal ultrasound is the diagnostic test of choice to evaluate a testicular nodule or mass. • MRI if US inconclusive. • AFP, beta-hCG. normal serum values do not exclude testicular cancer.
- 10. DIAGNOSIS - CSP •History - Pain: SOCRATE - Urinary, Sexual and Bowel functions. - Hx of: scrotal, inguinal, abdominal or pelvic surgeries. PVPS - history of psychological, physical or sexual abuse. • PE: - scrotal structures: concentrating on the testis, epididymides and vasa for any anatomic abnormalities and to localization. - scars, hernias or areas of tenderness. - PR; Tone, tenderness, enlargement. - Neurological examination of the lower limbs for sensory deficits and radiculopathy.
- 11. Diagnosis • Lab: Hxand PE directed • lower urinary tract symptoms or hematuria; Urine analysis. • Urethral discharge, or penile pain; gonorrhea and chlamydia. • Palpable abnormality/ mass; Scrotal ultrasound • routine scrotal ultrasound is debated. • Spermatic cord blockade is used as a diagnostic and therapeutic measure.
- 12. TREATMENT • Conservative therapies. •watchful waiting. • scrotal support. • heat or cold therapy. • avoidance of aggravating activities. • Psychological therapy & CBT. • catastrophic thinking. • irrational fear of injury. • pain distorted thinking. • Medical management • NSAIDs. • Antibiotics. • Tricyclic antidepressants. • Neuropathic Medications.
- 16. Reference • Diagnosis andManagement of Chronic Scrotal Pain, (AUA) https://drive.google.com/file/d/1-q44O1SFjMK2OoefMK3rSf96L9-55- xW/view • Nonacute scrotal conditions in adults, (UTD)
- 17.
Editor's Notes
- #5 a variety of psychiatric conditions, including depression, anxiety and schizophrenia may manifest as psychogenic pain.13, Its hard to direct this relation, which cause which
- #8 epididymitis, torsion, appendiceal torsion. cancer
- #11 Men with a history of abuse are at an increased risk for CSP
- #12 easy, safe and inexpensive imaging modality, and a normal ultrasound may help reassure Ultrasound has been shown to be highly sensitive and specific for detecting intrascrotal anatomic abnormalities, such as testicular tumors.33