๐ Stepwise Management of Scrotal Disorders
๐ Key Principles โ Nelson Ch 582
โข Undescended Testis: 4.5% at birth, 1.5% at 6 months. Orchiopexy by 12-18 months. Associated with infertility, malignancy (seminoma).
โข Testicular Torsion: Surgical emergency. TWIST score: swelling(2), hard(2), high-riding(1), absent cremasteric(1), nausea(1). Score โฅ5 โ emergent exploration.
โข Varicocele: Left-sided, 'bag of worms'. Treatment if testicular atrophy, pain, or abnormal semen analysis.
โข Hydrocele: Communicating (reduces with compression) vs noncommunicating. Resolves by 12-18 months.
โข Testicular Tumor: Yolk sac tumor (prepubertal), teratoma, germ cell tumor (adolescents). Painless mass โ ultrasound, tumor markers.
โ ๏ธ Testicular Torsion is a true emergency! Salvage rate 90% if explored within 6 hours, <10% after 24 hours. Do not delay for imaging if clinical suspicion high.