chronic scrotal pain.pptx

an overview of chronic scrotal pain and its most common causes

1. Overview of Chronic Scrotal Pain 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 or constant, 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% of patients will not have an identifiable etiology. “ self-palpation” orchitis. Psychological.

5. Varicocele   Dilatation of the 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. Management Up to date

7. Hydrocele   collection of peritoneal 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 R ound soft mass in the head of the epididymis. Main differential: epididymal cystadenoma or, rarely, cystadenocarcinoma E xamination: 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: Hx and 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.

13. Reference Diagnosis and Management of Chronic Scrotal Pain, (AUA) https://drive.google.com/file/d/1-q44O1SFjMK2OoefMK3rSf96L9-55-xW/view Nonacute scrotal conditions in adults, (UTD)

14. Thank you