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Kordeva S, Pidakev I, Tchernev G. Fine scalpel surgery: preserving the dartos muscle in a patient with scrotal and perigenital giant Buschke-Löwenstein tumors. Wien Med Wochenschr 2024:10.1007/s10354-024-01039-7. [PMID: 38587714 DOI: 10.1007/s10354-024-01039-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 03/07/2024] [Indexed: 04/09/2024]
Abstract
Giant condyloma acuminatum (GCA), alternatively referred to as a Buschke-Löwenstein tumor (BLT), is an uncommon, benign, but locally aggressive form of verrucous carcinoma. The condition usually affects the male population under the age of 50 years; however, there have been rare reports of pediatric cases. Various risk factors such as smoking, diabetes, promiscuous behavior, poor hygiene, immunosuppression, and others are linked to the development of this condition. We present the case of a 26-year-old male patient who came to the dermatology department with primary complaints of 10-year-old verrucous tumor formations located in the perigenital and perianal areas. Serological tests for AIDS, hepatitis B, hepatitis C, Chlamydia trachomatis, and syphilis were negative. The routine blood tests were slightly abnormal. Histological verification of condylomata acuminata of Buschke-Löwenstein was made. Given the sensitive areas, surgery was advised. With several fine undermining scalpel excisions, the lesions in the scrotal and perigenital areas were removed and the dartos muscle was preserved. Electrodissection and shave curettage were not performed. The postoperative period passed without complications and no recurrences in the perigenital area were reported. We believe that our case report represents the first documented surgical approach for scrotal Buschke-Löwenstein tumor using exclusively fine undermining scalpel surgery. A brief literature review of the condition is presented, focusing on the currently available treatment options and highlighting the potential effectiveness of the surgical approach.
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Affiliation(s)
- S Kordeva
- Onkoderma-Clinic for Dermatology, Venereology and Dermatologic Surgery, General Skobelev 26, 1606, Sofia, Bulgaria.
| | - I Pidakev
- Department of Common, Abdominal and Vascular Surgery, Medical Institute of Ministry of Interior, Sofia, Bulgaria
| | - G Tchernev
- Onkoderma-Clinic for Dermatology, Venereology and Dermatologic Surgery, General Skobelev 26, 1606, Sofia, Bulgaria
- Department of Dermatology and Venereology, Medical Institute of Ministry of Interior, General Skobelev 79, 1606, Sofia, Bulgaria
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2
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Elhag H, Al-Tairy F, Dahdaha MS, Shaeshaa A, Yigit Y. Inferior Vena Cava Thrombosis in a Patient with Factor V Leiden Syndrome Presenting with Scrotal Pain. Case Rep Med 2023; 2023:6234371. [PMID: 37790840 PMCID: PMC10545471 DOI: 10.1155/2023/6234371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 09/03/2023] [Accepted: 09/07/2023] [Indexed: 10/05/2023] Open
Abstract
Thrombosis in the inferior vena cava (IVC) is a rare but serious condition that can lead to significant morbidity and mortality. We present a case report of a 39-year-old male who presented to the emergency department with right flank pain that had progressed to severe back pain, bilateral flank pain, scrotal pain, and leg pain over the course of two days. The pain was severe enough to affect his daily activities. Laboratory investigations revealed a D-dimer level of 17 ng/mL, creatinine level of 110 µmol/L, and a white blood cell count of 10 × 109/L with a CRP level of 5 mg/L. Urine analysis was positive for blood. Doppler ultrasound of both legs showed deep vein thrombosis extending from the external iliac veins to the distal veins of both legs. Further investigation with computed tomography of the abdomen revealed a large thrombus in the distal vena cava extending to the renal artery and both external and internal iliac veins. The patient was diagnosed with Factor V Leiden syndrome based on genetic testing, which revealed a heterozygous mutation in the F5 gene. He was successfully treated with low molecular weight heparin and warfarin, and after five days of hospitalization, he was discharged with warfarin for long-term anticoagulation. This case report emphasizes the importance of considering IVC thrombosis in patients with a constellation of symptoms, including scrotal pain, and the role of genetic testing in identifying underlying hypercoagulable states.
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Affiliation(s)
- Helmy Elhag
- Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Fadl Al-Tairy
- Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar
| | | | - Ahmed Shaeshaa
- Department of Emergency Medicine, Lincoln County Hospital, Lincolnshire, UK
| | - Yavuz Yigit
- Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar
- Blizard Institute, Queen Mary University, London, UK
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Damrow T, Bellinger R, Lin J, Walker JA. An Unusual Case of Acute Scrotal Pain. Cureus 2023; 15:e45221. [PMID: 37842505 PMCID: PMC10576437 DOI: 10.7759/cureus.45221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2023] [Indexed: 10/17/2023] Open
Abstract
Patients frequently present to the emergency department with complaints of scrotal or testicular pain. Generally, there is an algorithmic approach to workup, which includes assessment for torsion, infection, or vascular causes, and musculoskeletal causes of pain are also sometimes considered. Spinal cord pathology, however, is less often explored as a cause of testicular pain. Here, we present a case of a 45-year-old man with end-stage renal disease and hypertension who presented with acute testicular pain. After a comprehensive workup, however, the source of pain was not initially found. Progression of the patient's symptoms led to the diagnosis of spontaneous spinal subdural hematoma. This atypical presentation of a rare diagnosis is also interesting due to the patient's concomitant diagnosis of an otherwise asymptomatic COVID-19 infection. While our case represents an atypical combination of clinical features, it also illustrates the importance of continued vigilance and ongoing workup when patients present with severe pain and unclear causes of their symptoms.
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Affiliation(s)
- Thomas Damrow
- Department of Emergency Medicine, Baylor Scott & White All Saints Medical Center, Fort Worth, USA
| | - Ryan Bellinger
- Department of Emergency Medicine, Baylor Scott & White All Saints Medical Center, Fort Worth, USA
| | - Judy Lin
- Department of Emergency Medicine, Baylor Scott & White All Saints Medical Center, Fort Worth, USA
- Department of Emergency Medicine, Burnett School of Medicine at Texas Christian University, Fort Worth, USA
| | - Jennifer A Walker
- Department of Emergency Medicine, Baylor Scott & White All Saints Medical Center, Fort Worth, USA
- Department of Emergency Medicine, Burnett School of Medicine at Texas Christian University, Fort Worth, USA
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Zanbak Mutlu ÖP, Tütüncü AÇ, Kendigelen P, Kara Esen B. Posterior transversus abdominis plane block versus lateral quadratus lumborum block in children undergoing open orchiopexy: a randomized clinical trial☆. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ELSEVIER) 2023:S0104-0014(23)00068-4. [PMID: 37429376 DOI: 10.1016/j.bjane.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 05/26/2023] [Accepted: 06/27/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND Due to the complex innervation of the testicle and spermatic cord, analgesic management can be challenging in orchiopexy. We aimed to compare the effects of posterior Transversus Abdominis Plane (TAP) and lateral Quadratus Lumborum Block (QLB) on analgesic use, pain, and parent satisfaction in unilateral orchiopexy. METHODS ASA I-III, aged 6 months - 12 years children undergoing unilateral orchiopexy were included to this double-blinded randomized trial. Patients were randomized into two groups with the closed envelope method before the surgery. Lateral QLB or posterior TAP block was applied under ultrasonography with 0.4 mL.kg-1 0.25% bupivacaine for both groups. The primary outcome was the assessment of additional analgesic usage in the peri-postoperative period. Evaluation of postoperative pain until 24 hours after surgery and parental satisfaction were also assessed as secondary outcomes. RESULTS A total of 90 patients were included in the analysis (45 patients in each group). The number of patients needing remifentanil was significantly higher in the TAP group (p < 0.001). The average FLACC (TAP: 2.74 ± 1.8, QLB: 0.7 ± 0.84) and Wong-Baker scores (TAP: 3.13 ± 2.42, QLB: 0.53 ± 1.12) were significantly higher for TAP (p < 0.001). Additional analgesic consumption at the 10th, 20th minutes, 6th, 16th, and 24th hours, especially after the 6th hour, were significantly higher for TAP. Parent satisfaction was significantly higher in the QLB group (p < 0.001). CONCLUSION Lateral QLB provided more effective analgesia than posterior TAP block in children undergoing elective open unilateral orchiopexy. CLINICAL TRIALS REGISTRY NCT03969316.
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Affiliation(s)
- Özgecan P Zanbak Mutlu
- Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of Anesthesiology and Reanimation, Istanbul, Turkey.
| | - Ayşe Ç Tütüncü
- Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of Anesthesiology and Reanimation, Istanbul, Turkey
| | - Pınar Kendigelen
- Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of Anesthesiology and Reanimation, Istanbul, Turkey
| | - Beril Kara Esen
- Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of Public Health, Istanbul, Turkey
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Dung PTV, Son TT, Son TQ, Tuan NM. Giant scrotal lipoma in Madelung's disease: A case report. Int J Surg Case Rep 2023; 106:108151. [PMID: 37119747 PMCID: PMC10163630 DOI: 10.1016/j.ijscr.2023.108151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 03/31/2023] [Accepted: 03/31/2023] [Indexed: 05/01/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Madelung disease is a rare condition of unknown etiology, characterized by large masses of subcutaneous fat in the upper body bilaterally. It rarely affects the lower extremities and genital region. CASE PRESENTATION Here, we report a patient with Donhouser's type III Madelung's disease. A 47-year-old male patient presented with a giant fatty scrotal tumor that caused deformation of the scrotum and penis, made it difficult to perform daily activities, and hindered sexual activity. The adipose tumor was completely removed using a midline scrotal incision. The scrotum was reconstructed with bilateral anterior and posterior scrotal skin flaps. The excess skin was cut into a wedge shape between the anterior and posterior scrotal regions. CLINICAL DISCUSSION At 3 months postoperatively, the scrotum was normal in shape and size, and the patient was able to perform personal activities and normal sexual activity. The surgical options, lipectomy results, and experiences drawn from the clinical cases have been discussed. CONCLUSION Giant scrotal lipomas are very rare in Madelung's disease. Lipectomy and scrotal reconstruction are required. Wedge-shaped scrotal skin excision in the midsection on each side of the scrotum removes excess skin, which could restore the shape and function of the penis and scrotum.
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Affiliation(s)
- Pham Thi Viet Dung
- Department of Plastic and Reconstructive Surgery, Bach Mai Hospital, Hanoi, Viet Nam; Faculty of Plastic and Reconstructive Surgery, Hanoi Medical University, Hanoi, Viet Nam; Department of Plastic and Reconstructive Surgery, Hanoi Medical University Hospital, Hanoi, Viet Nam.
| | - Tran Thiet Son
- Department of Plastic and Reconstructive Surgery, Bach Mai Hospital, Hanoi, Viet Nam; Faculty of Plastic and Reconstructive Surgery, Hanoi Medical University, Hanoi, Viet Nam.
| | - Truong Quoc Son
- Faculty of Plastic and Reconstructive Surgery, Hanoi Medical University, Hanoi, Viet Nam
| | - Nguyen Minh Tuan
- Urologic Surgery Department, Bach Mai Hospital, Hanoi, Viet Nam.
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Levang S, Henkelman M, Neish R, Zukerman W, Terrell B, Jackman V, Coyle S, Brahmbhatt J, Pukall C. "Blue balls" and sexual coercion: a survey study of genitopelvic pain after sexual arousal without orgasm and its implications for sexual advances. Sex Med 2023; 11:qfad016. [PMID: 37152302 PMCID: PMC10155057 DOI: 10.1093/sexmed/qfad016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/26/2023] [Accepted: 03/30/2023] [Indexed: 05/09/2023] Open
Abstract
Background Blue balls/vulva has received increasing interest from the public in recent years, sparking debate about genital physiology, controversy around "sexual release" as a treatment for this type of pain, and sexual consent. Aim This cross-sectional, mixed-methods online study aimed to evaluate the general understanding and frequency of blue balls/vulva and whether individuals have ever been pressured to continue sexual activity because of a partner's fears of experiencing pain without orgasm. Methods A total of 2621 individuals with a penis (n = 1483) or vagina (n = 1138) were recruited for an online survey on the experience of "blue balls/vulva." Quantitative analyses consisted primarily of descriptive statistics and chi-square analyses. Between-group differences were analyzed (based on whether respondents reported having a penis or vagina), and responses to open-ended questions were examined via thematic analysis. Outcomes The primary outcomes of interest were reports of the belief in blue balls/vulva, the frequency and pain characteristics of blue balls/vulva, and the incidence of being pressured to continue sexual activity due to a partner's fears of experiencing pain without orgasm. Results Results indicated that significantly more individuals with a penis than a vagina reported believing that blue balls are real, endorsed experiencing pain when they approached orgasm but did not ejaculate, and reported moderate and severe pain. Significantly more individuals with a vagina than a penis reported being pressured into a sexual act due to a partner's fear of experiencing pain without orgasm. Results from the thematic analysis indicated that participants recognized that those with a vagina are expected to act sexually to prevent their partners' experience of blue balls, despite agreement that this phenomenon should not be used to coerce or manipulate partners into engaging sexually. Clinical Implications Education on the frequency of this phenomenon and methods to relieve pain alternative to partnered sexual activity should be addressed in patients who present with this condition. Strengths and Limitations Although the survey was brief, it provided information from a relatively large sample about whether people believe that this phenomenon exists, how many experience it, how painful it is, and how often it has been used as an excuse for a partner to continue sexual activity. Conclusion Results indicated that severe pain exists in a minority of individuals, that solitary sexual and nonsexual activities can help to alleviate the discomfort, and that this pain is not a valid reason to continue unwanted sexual activity.
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Affiliation(s)
- Samantha Levang
- Department of Psychology, Queen’s University, Kingston, ON K7L3L3, Canada
| | - Megan Henkelman
- Department of Psychology, Queen’s University, Kingston, ON K7L3L3, Canada
| | - Robin Neish
- Department of Psychology, Queen’s University, Kingston, ON K7L3L3, Canada
| | | | | | | | - Shannon Coyle
- Department of Psychology, Queen’s University, Kingston, ON K7L3L3, Canada
| | | | - Caroline Pukall
- Corresponding author information: Dr. Caroline Pukall, Department of Psychology, Queen’s University, 62 Arch St, Kingston, ON K7L3L3, Canada.
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7
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Lai CZ, Chen SJ, Huang CP, Chen HY, Tsai MY, Liu PL, Chen YH, Chen WC. Scrotal Pain after Varicocelectomy: A Narrative Review. Biomedicines 2023; 11:biomedicines11041070. [PMID: 37189688 DOI: 10.3390/biomedicines11041070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 03/26/2023] [Accepted: 03/30/2023] [Indexed: 04/05/2023] Open
Abstract
Varicocele is a frequently encountered urological disorder, which has a prevalence rate of 8 to 15% among healthy men. However, the incidence is higher in male patients with primary or secondary infertility, with up to 35 to 80% of varicocele cases occurring in this population. The clinical manifestations of varicocele typically include the presence of an asymptomatic mass that feels like a “bag of worms”, chronic scrotal pain, and infertility. Most patients with varicocele only undergo varicocelectomy after conservative treatments have failed. Unfortunately, some patients may still experience persistent scrotal pain due to a recurrence of varicocele, the development of hydrocele, neuralgia, referred pain, ureteral lesions, or nutcracker syndrome. Therefore, clinicians should consider these conditions as potential causes of postoperative scrotal pain, and take measures to address them. Several factors can assist in predicting surgical outcomes for patients with varicocele. Clinicians should consider these factors when deciding whether to perform surgery and what type of surgical intervention to use. By doing so, they can increase the likelihood of a successful surgical outcome and minimize the risk of complications such as postoperative scrotal pain.
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Affiliation(s)
- Chien-Zhi Lai
- School of Medicine, College of Medicine, China Medical University, Taichung 404333, Taiwan
| | - Szu-Ju Chen
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung 407219, Taiwan
| | - Chi-Ping Huang
- School of Medicine, College of Medicine, China Medical University, Taichung 404333, Taiwan
- Department of Urology, China Medical University Hospital, Taichung 404327, Taiwan
| | - Huey-Yi Chen
- Graduate Institute of Integrated Medicine, College of Chinese Medicine, China Medical University, Taichung 404333, Taiwan
- Department of Obstetrics and Gynecology, China Medical University Hospital, Taichung 404327, Taiwan
| | - Ming-Yen Tsai
- Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833401, Taiwan
- Kaohsiung Municipal Feng Shan Hospital (Under the Management of Chang Gung Medical Foundation), Kaohsiung 830025, Taiwan
| | - Po-Len Liu
- Department of Respiratory Therapy, College of Medicine, Regenerative Medicine and Cell Therapy Research Center, Kaohsiung Medical University, Kaohsiung 807378, Taiwan
| | - Yung-Hsiang Chen
- Graduate Institute of Integrated Medicine, College of Chinese Medicine, China Medical University, Taichung 404333, Taiwan
- Department of Psychology, College of Medical and Health Science, Asia University, Taichung 413305, Taiwan
- Department of Medical Research, China Medical University Hospital, Taichung 404327, Taiwan
| | - Wen-Chi Chen
- Department of Urology, China Medical University Hospital, Taichung 404327, Taiwan
- Graduate Institute of Integrated Medicine, College of Chinese Medicine, China Medical University, Taichung 404333, Taiwan
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Sischka MF, Tentis ER, Helo S, Kohler TS, Collins CS, Ziegelmann MJ. Testicular Pain - Not Always What it Seems: A Cross-Sectional Assessment of Patients Presenting for Chronic Scrotal Content Pain at a Tertiary Care Center. Urology 2023; 174:18-22. [PMID: 36773956 DOI: 10.1016/j.urology.2023.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 01/04/2023] [Accepted: 01/15/2023] [Indexed: 02/11/2023]
Abstract
OBJECTIVE To review historical and examination findings in patients presenting to a tertiary care center for evaluation of Chronic Scrotal Content Pain (CSCP) defined by persistent/bothersome pain present for > 3-months. METHODS We performed a retrospective chart review of all patients presenting to our medical center for evaluation of CSCP. Pertinent information collected included historical data, physical examination findings, laboratory and imaging results, and treatments recommended by the assessing physician. The data was summarized to present a cross-sectional representation of patients presenting for CSCP. RESULTS 110 patients were identified. 80 patients (73%) had seen at least one prior urologist. 26 patients (24%) had undergone a prior unsuccessful surgical intervention for CSCP. Reproducible tenderness was present in 67% of patients including testicular tenderness in 50 (45%), epididymal tenderness in 60 (55%), and spermatic cord tenderness in 31 patients (28%). 33% of patients did not have any reproductible scrotal content tenderness on physical examination. Surgery was recommended in 57/110 patients (52%), including microdenervation in 22%. Musculoskeletal etiologies were suspected based on specific aspects of the history and physical examination in 43 patients (39%), prompting additional evaluation and/or referrals. CONCLUSION CSCP presents with a wide array of symptoms and many patients do not have reproducible findings on examination, suggesting alternative sources of pain such as referred pain from musculoskeletal causes. The history and physical examination should include assessments for concurrent abdominal, back, hip, and other genital/pelvic pain that may suggest alternative diagnoses and referrals for appropriate treatment.
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Affiliation(s)
| | | | - Sevann Helo
- Department of Urology, Mayo Clinic, Rochester, MN
| | | | - C Scott Collins
- Department of Urology, Mayo Clinic, Rochester, MN; Department of Medicine, Mayo Clinic, Rochester, MN
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Werneburg GT, Keslar KS, Gotwald P, Doolittle J, Vij SC, Berglund R, Shoskes DA. Men With Chronic Orchialgia Exhibit Differential Neuroinflammatory Gene Expression Relative to Asymptomatic Controls. Urology 2022; 166:159-163. [PMID: 35644304 DOI: 10.1016/j.urology.2022.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 05/06/2022] [Accepted: 05/19/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To identify differences in neuroinflammatory gene expression in individuals with chronic orchialgia (CO) compared to asymptomatic controls. METHODS Vas deferens, spermatic cord fascia, blood, and urine were collected from 9 men with CO at time of microscopic spermatic cord denervation and 7 asymptomatic controls at time of vasectomy. RNA was isolated and analyzed with the NanoString Human Neuroinflammation panel. Data were normalized, gene expression fold changes and enriched pathways relative to asymptomatic controls were determined. Gene expression was considered significantly different if there was a >2-fold change and P-value <.05 relative to controls. RESULTS Mean patient age was 51 years and median symptom duration 12 months. There were 26 genes with significantly differential expression in vas deferens. cFos, a marker of nociceptive pain, had the greatest difference (30.2-fold change, P <.000001). Enriched pathways in vas deferens included nerve function, matrix remodeling, and innate immune responses. In fascia, cFos also had the greatest differential expression (38-fold, P = .000002), followed by S100A12 (11-fold, inducer of innate immune response). Enriched pathways in fascia included nerve function and inflammation. In blood, there were no differentially expressed genes, and in urine there were 95 differentially expressed genes. CONCLUSION Men with CO have a diverse set of neuroinflammatory genes with differential expression in tissue and urine relative to healthy controls. These findings confirm pathologic changes in tissue targeted by denervation surgery, and suggest molecular changes in neuropathic pain that could lead to biomarker identification and novel treatment.
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Affiliation(s)
- Glenn T Werneburg
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH.
| | - Karen S Keslar
- Department of Immunology, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Paige Gotwald
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Johnathan Doolittle
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Sarah C Vij
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Ryan Berglund
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Daniel A Shoskes
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH
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Functional histology of human scrotal wall layers and their overlooked relation with infertility: a narrative review. Int J Impot Res 2022:10.1038/s41443-022-00573-5. [PMID: 35488082 DOI: 10.1038/s41443-022-00573-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 04/04/2022] [Accepted: 04/06/2022] [Indexed: 11/08/2022]
Abstract
Male infertility currently contributes to nearly half of the reported infertility cases. Scrotal wall layers play a cardinal role in regulating testicular physiology. However, few studies have focused on the functional histology of these layers and their relations with infertility in humans. The objective of the present narrative review is to collate novel insights into the functional histology of the human scrotal wall layers and their relation with infertility. The data was extracted from articles published between 1946 and 2021. The study was performed between January and December 2021. 71 original studies have been included in this review. Despite the fact that few studies have presented detailed functional histology of the human scrotal wall layers, this narrative review elucidates the possible influence of scrotal histology on infertility. Scrotal wall layers-associated pathologies may induce infertility by various mechanisms. They can impose mechanical forces that may affect the testicular histology and stimulate testicular inflammation. Moreover, they may induce testicular hyperthermia. Various unanswered clinical questions have been identified in this narrative review. More clinical studies are needed to assess the effect of alterations in the components of the scrotal wall layers on fertility (e.g., due to the exposure to metabolic and/or psychological stressors). In addition, testing the effectiveness of various pharmacological/surgical interventions to treat scrotal wall layers-associated pathologies will provide more insights into infertility treatment.
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11
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Fink BA, Son Y, Thomas B, Mueller TJ, Berkman DS. Emphysematous Pyelonephritis From a Perinephric Hematoma Complicated by Fournier’s Gangrene: A Case Report. Cureus 2022; 14:e21612. [PMID: 35233300 PMCID: PMC8881273 DOI: 10.7759/cureus.21612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2022] [Indexed: 11/05/2022] Open
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12
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Osmani F, Ferrer F, Barnett NR. Regional anesthesia for ambulatory pediatric penoscrotal procedures. J Pediatr Urol 2021; 17:836-844. [PMID: 34400101 DOI: 10.1016/j.jpurol.2021.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 07/14/2021] [Accepted: 07/19/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND/PURPOSE Pediatric urology procedures are amongst the most commonly performed in children. The need for proactive treatment of pain is essential for optimal patient care. Current guidelines recommend the routine use of regional anesthesia in children as appropriate unless contraindicated. Given the commonality of urologic procedures in children, it is essential to understand the indications for and the utility of regional anesthesia. METHODS The current literature was searched using PubMed as the primary platform. Search words included 'dorsal penile nerve block,' 'pudendal nerve block,' 'ring block,' 'spinal anesthesia,' and 'caudal,' along with 'pediatric', 'circumcision,' 'hypospadias,' 'urology', and 'urological surgery' as part of the keywords of the search. RESULTS The articles resulting from the literature search were reviewed for content, clarity and study design by two co-authors, and agreement determined the incorporation into the review. Additionally, a detailed description of study design, regional anesthetic technique, local anesthetic(s) used, and outcomes of each study referenced was incorporated into the supplemental table. CONCLUSION Given the variance in block technique and local anesthetic choice amongst the current reported studies in the literature, it is difficult to truly compare and infer superiority of the regional anesthetic choices for ambulatory penoscrotal procedures. When choosing a regional anesthetic technique, careful consideration must be placed on block coverage, severity of expected pain and surgical duration of the procedure, type and dose of local anesthetic, as well as the patient's past medical history and anatomy. Moreover, the regional block chosen should result from a thorough preoperative discussion between the surgeon and the anesthesiologist.
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Affiliation(s)
- Feroz Osmani
- Department of Anesthesiology, Mount Sinai Hospital, Icahn School of Medicine, New York, NY, USA
| | - Fernando Ferrer
- Department of Urology, Mount Sinai Hospital, Icahn School of Medicine, New York, NY, USA
| | - Natalie R Barnett
- Department of Anesthesiology, Medical University of South Carolina, Charleston, SC, USA.
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13
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Chu ECP. Taming of the Testicular Pain Complicating Lumbar Disc Herniation With Spinal Manipulation. Am J Mens Health 2021; 14:1557988320949358. [PMID: 32772625 PMCID: PMC7418242 DOI: 10.1177/1557988320949358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Degenerative disease of the lumbar spine is often ignored as a potential cause of testicular pain because the exact link between the two remains uncertain. This article reports the case of a 60-year-old man with a 3-year history of low back pain and unexplained right testicular pain for 2 years. Painful symptoms were negatively affecting his social, physical, and sexual functions. After failure to achieve pain relief through multiple types of therapy, the patient sought chiropractic treatment for his condition. Lumbar spine magnetic resonance imaging (MRI) revealed disc protrusion at the L1/L2, L3/L4, and L4/L5 segments causing thecal sac indentations. Due to the absence of direct testicular causes, the medical impression was chronic testicular pain (CTP) complicating lumbar disc disease. The patient experienced regular improvement in his low back and testicular pain with complete resolution of both after 8 weeks of chiropractic treatment. This article describes an overlook of the etiology of this patient's testicular pain and a successful option in treating the patient. CTP has multifactorial etiology. An excellent treatment outcome depends heavily on recognizing the origin of the pain.
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Affiliation(s)
- Eric Chun Pu Chu
- New York Chiropractic and Physiotherapy Centre, Hong Kong, China
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Chu ECP, Wong AYL. Chronic Orchialgia Stemming From Lumbar Disc Herniation: A Case Report and Brief Review. Am J Mens Health 2021; 15:15579883211018431. [PMID: 34027733 PMCID: PMC8141999 DOI: 10.1177/15579883211018431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Chronic orchialgia can be the result of pathological processes of the scrotal contents or stem from non-intrascrotal structures. Successful pain management depends on identifying the source of localized or referred pain. This is a case report of a 39-year-old male sports coach who presented with low back pain, right orchialgia, and sciatica refractory to conservative management. Magnetic resonance (MR) imaging revealed disc protrusion at L3/L4 and L4/L5 levels. Positive outcomes in relieving back and testicular pain were obtained after a total of 30 chiropractic sessions over a 9-week period. The evidence of the subjective improvement was corroborated by regression of the herniated discs documented on the repeat MR imaging. While chronic orchialgia is not an uncommon problem for men of all ages, it has seldom been described in association with lumbar discogenic disease. The current study provided preliminary support for a link between orchialgia and lumbar disc herniation. Chiropractic manipulation had provided a mechanistic alleviation of noxious lumbar stimuli, leading to symptomatic and functional improvements.
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Affiliation(s)
- Eric Chun Pu Chu
- New York Chiropractic and Physiotherapy Centre, Hong Kong, China
| | - Arnold Yu Lok Wong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
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15
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Beamer MR, Pinkhasov A, Kravchick S. Preoperative Modified Spermatic Cord Block Predicts Success in Candidates for Microscopic Spermatic Cord Denervation. Urology 2021; 156:31-36. [PMID: 33961892 DOI: 10.1016/j.urology.2021.04.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 03/07/2021] [Accepted: 04/04/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine the utility of a modified spermatic cord block (MSCB) that targets known contributors to refractory chronic scrotal content pain (CSCP) at predicting postoperative pain relief following a microscopic spermatic cord denervation (MSCD). METHODS A MSCB was performed in all patients with refractory CSCP. This was performed by injecting anesthetic circumferentially around the vas deferens and over the external ring. Patients with >50% pain reduction were offered MSCD. Baseline, post-block, and postoperative pain was assessed. Age, prior groin surgery, and post-block pain free period were recorded. A multivariate linear regression model was used to determine predictors of surgical success. RESULTS Fifty-two patients underwent a MSCB. Forty-six (88%) had an adequate response and underwent MSCD. All patients saw improvement in pain postoperatively with an average reduction of 80% (4 < 50%; 7 50-69%; 35 ≥ 70%). On multivariate linear regression analysis, pain reduction following MSCD was an independent predictor of postoperative improvement (P < 0.001). No other factors, including post-block pain free period or prior surgery predicted success. CONCLUSIONS The described MSCB can be utilized as an independent predictor of success following MSCD. Post-block pain free period was not associated with postoperative pain level. The MSCB may help identify candidates for MSCD that would be missed with the traditional block.
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Affiliation(s)
- Matthew R Beamer
- Department of Urology, SUNY Upstate Medical University, Syracuse, NY.
| | | | - Sergey Kravchick
- Department of Urology, SUNY Upstate Medical University, Syracuse, NY; Department of Urology, United Health Services, Johnson City, NY
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16
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Pheochromocytoma Presenting as Testicular Pain: An Unusual Case Report. Case Rep Endocrinol 2021; 2021:6699409. [PMID: 33953991 PMCID: PMC8062206 DOI: 10.1155/2021/6699409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/07/2021] [Accepted: 03/29/2021] [Indexed: 11/18/2022] Open
Abstract
Pheochromocytoma (PCC) is a rare catecholamine-secreting tumor that arises from chromaffin cells of the adrenal medulla which are derived from the neural crest. This report illustrates a 51-year-old Caucasian male with a history of hypertension diagnosed two years ago who presented to the hospital due to acute onset of right testicular pain of 3-day duration. Laboratory results and imaging revealed a presumptive diagnosis of PCC. The patient had undergone robot-assisted laparoscopic right adrenalectomy 14 days after being diagnosed with PCC due to perioperative management with phenoxybenzamine. The final pathology report revealed a PCC. At follow-up two weeks after discharge, the patient reported complete resolution of his testicular pain.
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Campo I, Valentino M, Sidhu PS, Magi Meconi L, Van Nieuwenhove S, Cova MA, Derchi LE, Bertolotto M. Nonscrotal Causes of Acute Scrotum. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:597-605. [PMID: 32790121 DOI: 10.1002/jum.15431] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 07/03/2020] [Accepted: 07/05/2020] [Indexed: 06/11/2023]
Abstract
Acute scrotum is characterized by intense acute scrotal pain, which may be associated with other symptoms and signs such as abdominal pain, inflammation, and fever. Many pathologic conditions can present in this way, most which involve the scrotal contents. Nonscrotal conditions, however, can rarely present clinically only as acute scrotum: among them, renal colic, aneurysm rupture or other causes of retroperitoneal hemorrhage, primary abdominal or pelvic tumors and metastases, pancreatitis, pelvic inflammation, and muscle injuries. The pathophysiologic characteristics of the clinical presentation, clues for diagnosis, and imaging features of a series of nonscrotal lesions presenting clinically with acute scrotal pain are herein reported and illustrated. In patients presenting with acute scrotal symptoms and normal scrotal ultrasound findings, nonscrotal causes of acute scrotal pain should be considered in the differential diagnosis. Therefore, an ultrasound investigation of the abdomen, groin, and thighs is indicated.
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Affiliation(s)
- Irene Campo
- Department of Radiology, Ospedale Civile di Conegliano, Conegliano, Italy
| | - Massimo Valentino
- Department of Radiology, Ospedale di Tolmezzo, Azienda Sanitaria Universitaria Friuli Centrale, Tolmezzo, Italy
| | - Paul S Sidhu
- Department of Radiology, King's College Hospital National Health Service Foundation Trust, London, UK
| | - Luca Magi Meconi
- Department of Radiology, University of Trieste, Ospedale di Cattinara, Trieste, Italy
| | | | - Maria Assunta Cova
- Department of Radiology, University of Trieste, Ospedale di Cattinara, Trieste, Italy
| | - Lorenzo E Derchi
- Department of Health Sciences, Radiology Section, University of Genoa, Genoa, Italy
| | - Michele Bertolotto
- Department of Radiology, University of Trieste, Ospedale di Cattinara, Trieste, Italy
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Al-Omar K, Bakkar S, Spinelli C. Introducing a new scrotal orchiopexy technique: The fat anchor orchiopexy. J Pediatr Surg 2021; 56:632-634. [PMID: 33189298 DOI: 10.1016/j.jpedsurg.2020.10.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 10/18/2020] [Accepted: 10/24/2020] [Indexed: 11/28/2022]
Abstract
Cryptorchidism is the most common congenital anomaly of the male genital tract. Cryptorchidism is associated with potentially serious consequences including reduced fertility, increases risk of cancer, susceptibility to torsion and traumatic injury, as well as future psychological problems related to an abnormal scrotal appearance. The mainstay of orchiopexy is to achieve an adequate tension-free and permanent scrotal fixation of the testis; one that prevents recurrent ascent. A number of suggestions have been made regarding keeping the testis in the scrotal position once it was brought down in the scrotum without tension. Several techniques for testicular fixation have been described to date; however, the optimal method remains controversial. We herein introduce a novel scrotal orchidopexy technique. This innovative fixation technique utilizes the sub-scrotal fat as a permanent anchor for fixing the low-lying cryptorchid testicle in the scrotum through a trans-scrotal incision. Therefore, the procedure was named "the fat anchor orchiopexy". We believe our method will give better options for scrotal fixation especially in cases of low-lying cryptorchid testes. This article provides a detailed description of this new fixation technique.
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Affiliation(s)
- Khaled Al-Omar
- Department of Surgery, Faculty of Medicine, the Hashemite University, Zarqa 13133, Jordan.
| | - Sohail Bakkar
- Department of Surgery, Faculty of Medicine, the Hashemite University, Zarqa 13133, Jordan
| | - Claudio Spinelli
- Department of Pediatric Surgery, the University of Pisa, Pisa 56124, Italy
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19
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Schmid SM, Genter CI, Heinemann C, Steinhoff-Wagner J. Impact of tearing spermatic cords during castration in live and dead piglets and consequences on welfare. Porcine Health Manag 2021; 7:17. [PMID: 33583429 PMCID: PMC7883445 DOI: 10.1186/s40813-021-00200-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 02/02/2021] [Indexed: 11/11/2022] Open
Abstract
Background Although the tearing of tissues during castration is forbidden in the EU, it is still routinely applied in many countries. The goal of this study was to evaluate vocalizations and movements of male piglets undergoing castration by applying different techniques and pain treatments based on scores under practical conditions (Trial 1, n = 50) and to investigate anatomical features after castration of dead piglets with different techniques (Trial 2, n = 28). Results In Trial 1, treatment groups did not significantly influence the duration of castration. Both the duration of vocalization and the scores for vocalizations and movements were lower in piglets castrated under general anesthesia (P < 0.05). Behavior scores in conscious piglets did not differ. The incision and extraction caused lower vocalizations and movements than the pulling and severing of spermatic cords (P < 0.01). Movements were more intense during tearing of the spermatic cords than during cutting at the first and second severing (P < 0.01). In both trials, the remains of spermatic cords protruded tendentially more often from castration wounds after severing by tearing (P < 0.09). In Trial 2, the minimum, mean and maximum lengths of the testicles and spermatic cords were extended when severing was realized by tearing (P < 0.01). The mean relative testicle weight of 1.05‰ in dead piglets castrated by tearing was larger than that in dead piglets castrated by cutting (0.91‰) (P < 0.05). Conclusions The trials uncovered significant differences between behavior expressed by piglets castrated by tearing or cutting, indicating a higher pain level in the tearing group. It was found that the castration technique tearing increased the amount of removed tissues and might cause intraabdominal damage to the remaining tissues and vessels in a yet unknown dimension. These findings should be considered for implementation and stricter enforcement of the ban on tearing for castration. Supplementary Information The online version contains supplementary material available at 10.1186/s40813-021-00200-7.
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Affiliation(s)
- Simone M Schmid
- Institute of Animal Science, University of Bonn, 53115, Bonn, Germany
| | - Chiara I Genter
- Institute of Animal Science, University of Bonn, 53115, Bonn, Germany
| | - Céline Heinemann
- Institute of Animal Science, University of Bonn, 53115, Bonn, Germany
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Oh PJ, Bajic P, Lundy SD, Ziegelmann M, Levine LA. Chronic Scrotal Content Pain: a Review of the Literature and Management Schemes. Curr Urol Rep 2021; 22:12. [PMID: 33447905 DOI: 10.1007/s11934-020-01026-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE OF REVIEW Chronic scrotal content pain (CSCP) is a complex condition with multiple etiologies that requires a thorough understanding of its pathophysiology, workup, and treatment options. We performed a comprehensive and contemporary review to augment our current understanding of CSCP. RECENT FINDINGS We discuss new advances in CSCP-specific pain questionnaires, modern studies of microscopic spermatic cord denervation and its variations, and novel techniques including electric nerve stimulation and cryoablation in addition to randomized control trials with significant negative findings. We also present literature focusing on the prevention of CSCP secondary to surgical iatrogenic causes. The constantly evolving literature of CSCP has led to the significant evolution in its diagnosis and treatment, from oral medications to salvage options after microscopic spermatic cord denervation. With each advance, we come closer to developing a more thorough, evidence-based algorithm to guide urologists in treatment of CSCP.
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Affiliation(s)
- Paul J Oh
- Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Ave, Building Q10-1, Cleveland, OH, 44195, USA
| | - Petar Bajic
- Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Ave, Building Q10-1, Cleveland, OH, 44195, USA.
| | - Scott D Lundy
- Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Ave, Building Q10-1, Cleveland, OH, 44195, USA
| | | | - Laurence A Levine
- Division of Urology, Rush University Medical Center, Chicago, IL, USA
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21
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Anderson E, Pascoe C, Sathianathen N, Katz D, Murphy D, Lawrentschuk N. Subinguinal orchiectomy—A minimally invasive approach to open surgery. BJUI COMPASS 2020; 1:160-164. [PMID: 35475209 PMCID: PMC8988733 DOI: 10.1002/bco2.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/08/2020] [Accepted: 07/12/2020] [Indexed: 11/10/2022] Open
Affiliation(s)
- Elliot Anderson
- Department of Surgery Monash University Clayton VIC Australia
- Department of Urology Western Health Footscray VIC Australia
| | - Claire Pascoe
- Division of Cancer Surgery Peter MacCallum Cancer Centre East Melbourne VIC Australia
| | - Niranjan Sathianathen
- Division of Cancer Surgery Peter MacCallum Cancer Centre East Melbourne VIC Australia
| | - Darren Katz
- Department of Urology Western Health Footscray VIC Australia
- Men’s Health Melbourne Melbourne VIC Australia
| | - Declan Murphy
- Division of Cancer Surgery Peter MacCallum Cancer Centre East Melbourne VIC Australia
- Sir Peter MacCallum Department of Oncology University of Melbourne Parkville VIC Australia
| | - Nathan Lawrentschuk
- Division of Cancer Surgery Peter MacCallum Cancer Centre East Melbourne VIC Australia
- Department of Urology Royal Melbourne Hospital Melbourne VIC Australia
- Department of Surgery The University of Melbourne Melbourne VIC Australia
- EJ Whitten Centre for Prostate Cancer Research Richmond VIC Australia
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22
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Abstract
Ultrasound is the imaging modality of choice to evaluate the scrotum because of its high resolution, Doppler capabilities, availability, and lack of ionizing radiation. Acute urologic emergencies diagnosed with ultrasound include testicular torsion, testicular rupture, and Fournier gangrene. The radiologist's knowledge of sonographic features of vascular, infectious, traumatic, and benign and malignant processes that occur in the scrotum coupled with the patient's presenting symptoms, age, and physical examination allows for the correct diagnosis of a wide spectrum of scrotal pathology.
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Affiliation(s)
- Kristin Rebik
- Department of Radiological Sciences, University of Oklahoma Health Sciences Center, Garrison Tower, Suite 4G4250, Oklahoma City, OK 73104, USA.
| | - Jason M Wagner
- Department of Radiological Sciences, University of Oklahoma Health Sciences Center, Garrison Tower, Suite 4G4250, Oklahoma City, OK 73104, USA
| | - William Middleton
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 South Kingshighway Boulevard, St Louis, MO 63110, USA
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23
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Hassanain M, Murphy P. Dorsal Root Ganglion Stimulation for the Treatment of Bilateral Intractable Chronic Testicular Pain. Neuromodulation 2018; 22:115-116. [DOI: 10.1111/ner.12805] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 05/10/2018] [Accepted: 05/29/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Mohamed Hassanain
- Pain Management & Neuromodulation Centre, St. Vincent's University Hospital; Dublin Ireland
| | - Paul Murphy
- Pain Management & Neuromodulation Centre, St. Vincent's University Hospital; Dublin Ireland
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Tan WP, Levine LA. What Can We Do for Chronic Scrotal Content Pain? World J Mens Health 2017; 35:146-155. [PMID: 29282906 PMCID: PMC5746485 DOI: 10.5534/wjmh.17047] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 10/22/2017] [Accepted: 11/12/2017] [Indexed: 11/15/2022] Open
Abstract
Chronic scrotal content pain remains one of the more challenging urological problems to manage. This is a frustrating disorder to diagnose and effectively treat for both the patient and clinician, as no universally accepted treatment guidelines exist. Many patients with this condition end up seeing physicians across many disciplines, further frustrating them. The pathogenesis is not clearly understood, and the treatment ultimately depends on the etiology of the problem. This article reviews the current understanding of chronic scrotal content pain, focusing on the diagnostic work-up and treatment options.
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Affiliation(s)
- Wei Phin Tan
- Department of Urology, Rush University Medical Center, Chicago, IL, USA
| | - Laurence A Levine
- Department of Urology, Rush University Medical Center, Chicago, IL, USA.
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