0071643192.pdf

RENAL AND GENITOURINARY

EMERGENCIES

Epididymitis exam findings:

Swollen tender epididymis

Relief with elevation of

scrotum (Prehn sign)

Normal cremasteric reflex

TREATMENT

■ Supportive care with analgesia, bed rest, elevation of scrotum

■ Antibiotics

■ Prepubertal boys: Augmentin or trimethoprim/sulfamethoxazole

■ Men <35 years: Ceftriaxone and doxycycline

■ Men≥35 years: Fluoroquinolone

■ Referral to urologist

■ Criteria for admission:

■ Immunocompromised

■ Intractable pain

■ Complicating abscess

■ Failure of therapy

■ Bacteremia

■ Bilateral involvement

ORCHITIS

Orchitis is an acute infection involving the testis. It most commonly is due

to secondary spread of bacterial epididymitis (see above) but may be viral in

nature, most commonly due to mumps. Orchitis is typically unilateral (even

viral).

SYMPTOMS/EXAM

■ Testicular pain, swelling, and tenderness

■ Pain may be out of proportion to exam findings

■ Fevers/chills

■ If mump related, may be associated with parotitis and other nonspecific viral

symptoms

DIAGNOSIS

■ As with epididymitis, above

TREATMENT

■ If viral, supportive therapy only

■ If bacterial, treat as above for epididymitis.

A 19-year-old male is crossing his campus to class and experiences

sudden onset of L flank and testicular pain. He has a history of kidney

stones and reports that this pain is as severe as with previous kidney

stones. On presentation to the ED, he has minimal costovertebral angle tender-

ness, minimal left lower quadrant tenderness, and a diffusely tender L testicle

with loss of cremasteric reflex. What is the first test that should be ordered?

Testicular ultrasound with Doppler. Obtain immediate urologic consultation.

Although testicular torsion usually occurs following strenuous activity, it may

occur after minimal exertion or even during sleep. Pain is usually severe and

felt in the left lower quadrant, inguinal canal, or testes. On examination, the

involved testis is usually firm and tender and rides higher than the unaffected

testicle.