0071643192.pdf

RENAL AND GENITOURINARY

EMERGENCIES

TREATMENT

■ Supportive care with analgesia
■ Suprapubic catheter if urinary drainage needed
■ Immediate urologic consult for surgical repair

TESTICULAR MASSES

Hydrocele

A collection of fluid in the tunica vaginalis. Communicating hydroceles
occur when the processus vaginalis fails to obliterate and leaves a potential
space between the peritoneum and scrotum. Noncommunicating hydroceles
result from an imbalance between the production and absorption of fluid by
the tunica vaginalis.

SYMPTOMS/EXAM

■ Scrotal fullness, which may be accompanied by pain with palpation
■ Transillumination may illustrate a homogenous glow without presence of
shadows.

DIAGNOSIS

■ Doppler ultrasound can be used to identify and determine the cause of
hydrocele.

TREATMENT

■ Supportive care
■ Urology referral for possible surgical intervention

Varicocele

Varicocele is a collection of venous varicosities of the spermatic veins due to
incomplete drainage of the pampiniform plexus. It is most common in adoles-
cent males. Suspect IVC compression or thrombosis if R sided and obstruction
of the L renal vein from renal cell carcinoma if L sided.

SYMPTOMS/EXAM

■ Scrotal mass or swelling
■ “Bag of worms” with examination and palpation superior and posterior to
the testis

DIAGNOSIS

■ Clinical examination with abdominal CT if suspected vascular compression

Tumors

Most commonly seminomas, but also may be embryonal cell cancer or teratoma

Hydroceles transilluminate

with a homogenous glow.

On examination varicoceles

feel like a “bag of worms.”