Scrotal swelling
Scrotal swelling: Excerpt from Handbook of Signs & Symptoms (Third Edition)
Scrotal swelling occurs when a condition affecting the testicles, epididymis, or scrotal skin produces edema or a mass; the penis may be involved. Scrotal swelling can affect males of any age. It can be unilateral or bilateral and painful or painless.
The sudden onset of painful scrotal swelling suggests torsion of a testicle or testicular appendages, especially in a prepubescent male. This emergency requires immediate surgery to untwist and stabilize the spermatic cord or to remove the appendage.
Emergency interventions
If severe pain accompanies scrotal swelling, ask the patient when the swelling began. Using a Doppler stethoscope, evaluate blood flow to the testicle. If it’s decreased or absent, suspect testicular torsion and prepare the patient for surgery. Withhold food and fluids, insert an I.V. line, and apply an ice pack to the scrotum to reduce pain and swelling. An attempt may be made to untwist the cord manually, but even if this is successful, the patient may still require surgery for stabilization.
History and physical examination
If the patient isn’t in distress, proceed with the history. Ask about injury to the scrotum, urethral discharge, cloudy urine, increased urinary frequency, and dysuria. Is the patient sexually active? When was his last sexual contact? Does he have a history of sexually transmitted disease? Find out about recent illnesses, particularly mumps. Does he have a history of prostate surgery or prolonged catheterization? Does changing his body position or level of activity affect the swelling?
Take the patient’s vital signs, especially noting a fever, and palpate his abdomen for tenderness. Then examine the entire genital area. Assess the scrotum with the patient supine and standing. Note its size and color. Is the swelling unilateral or bilateral? Do you see signs of trauma or bruising? Are there rashes or lesions present? Gently palpate the scrotum for a cyst or lump. Note especially tenderness or increased firmness. Check the testicles’position in the scrotum. Finally, transilluminate the scrotum to distinguish a fluid-filled cyst from a solid mass. (A solid mass can’t be transilluminated.)
Medical causes
Epididymal cysts
Located in the head of the epididymis, epididymal cysts produce painless scrotal swelling.
Epididymitis
Key features of inflammation are pain, extreme tenderness, and swelling in the groin and scrotum. The patient waddles to avoid pressure on the groin and scrotum during walking. He may have a high fever, malaise, an urethral discharge and cloudy urine, and lower abdominal pain on the affected side. His scrotal skin may be hot, red, dry, flaky, and thin.
Hydrocele
Fluid accumulation produces gradual scrotal swelling that’s usually painless. The scrotum may be soft and cystic or firm and tense. Palpation reveals a round, nontender scrotal mass.
Idiopathic scrotal edema
Swelling occurs quickly with idiopathic scrotal edema and usually disappears within 24 hours. The affected testicle is pink.
Orchitis (acute)
Mumps, syphilis, or tuberculosis may precipitate orchitis, which causes sudden painful swelling of one or, at times, both testicles. Related findings include a hot, reddened scrotum; a fever of up to 104° F (40° C); chills; lower abdominal pain; nausea; vomiting; and extreme weakness. Urinary signs are usually absent.
Scrotal trauma
Blunt trauma causes scrotal swelling with bruising and severe pain. The scrotum may appear dark or bluish.
Spermatocele
Spermatocele is a usually painless cystic mass that lies above and behind the testicle and contains opaque fluid and sperm. Its onset may be acute or gradual. Less than 1 cm in diameter, it’s movable and may be transilluminated.
Testicular torsion
Most common before puberty, testicular torsion is a urologic emergency that causes scrotal swelling; sudden, severe pain; and, possibly, elevation of the affected testicle within the scrotum. It may also cause nausea and vomiting.
Testicular tumor
Typically painless, smooth, and firm, a testicular tumor produces swelling and a sensation of excessive weight in the scrotum.
Torsion of a hydatid of Morgagni
Torsion of this small, pea-sized cyst severs its blood supply, causing a hard, painful swelling on the testicle’s upper pole.
Other causes
Surgery
An effusion of blood from surgery can produce a hematocele, leading to scrotal swelling.
Special considerations
Keep the patient on bed rest and administer an antibiotic. Provide adequate fluids, fiber, and stool softeners. Place a rolled towel between the patient’s legs and under the scrotum to help reduce severe swelling. Or, if the patient has mild or moderate swelling, advise him to wear a loose-fitting athletic supporter lined with a soft cotton dressing. For several days, administer an analgesic to relieve his pain. Encourage sitz baths, and apply heat or ice packs to decrease inflammation.
Prepare the patient for needle aspiration of fluid-filled cysts and other diagnostic tests, such as lung tomography and a computed tomography scan of the abdomen, to rule out malignant tumors.
Pediatric pointers
A thorough physical assessment is especially important for children with scrotal swelling, who may be unable to provide history data. In children up to age 1, a hernia or hydrocele of the spermatic cord may stem from abnormal fetal development. In infants, scrotal swelling may stem from ammonia-related dermatitis, if diapers aren’t changed often enough. In prepubescent males, it usually results from torsion of the spermatic cord.
Other disorders that can produce scrotal swelling in children include epididymitis (rare before age 10), traumatic orchitis from contact sports, and mumps, which usually occurs after puberty.
Book Source Details
- Book Title: Handbook of Signs & Symptoms (Third Edition)
- Author(s): Springhouse
- Year of Publication: 2006
- Copyright Details: Handbook of Signs & Symptoms (Third Edition), Copyright © 2006 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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