From the Guidelines
Emergency room precautions for male genital concerns require immediate medical attention for severe pain, trauma, priapism, testicular torsion, or significant swelling and bleeding, with a focus on prompt evaluation and treatment to prevent permanent damage and reduce morbidity and mortality. For testicular torsion, which is a surgical emergency, prompt evaluation is critical as tissue death can occur within 4-6 hours 1. Patients should not take pain medications before assessment as this may mask symptoms. When arriving at the ER, provide clear information about the onset, duration, and severity of symptoms.
Key Considerations
- For trauma cases, apply gentle pressure to control bleeding and use cold compresses to reduce swelling before arrival.
- For priapism, especially if medication-induced by drugs like sildenafil (Viagra), trazodone, or injectable ED medications, inform medical staff about all medications taken.
- Infections presenting with fever, discharge, or severe pain may require antibiotics like ceftriaxone 1000 mg i.m. or i.v. plus a course of an antibiotic active against Chlamydia trachomatis for suspected gonorrhea or epididymitis 1.
- A clinical assessment, including midstream urine for culture, urethral swab/smear, and scrotal ultrasound examination, is essential for diagnosis and treatment 1.
- The most critical step is to prioritize prompt medical attention, as delays in treatment can lead to permanent damage, increased morbidity, and mortality.
Diagnostic Considerations
- The acute scrotum is a medical emergency defined as scrotal pain, swelling, and redness of acute onset, from minutes to 1 to 2 days 1.
- Etiologies of acute scrotum are numerous, and rapid accurate diagnosis is essential to appropriately triage potentially surgical and irreversible conditions from patients for whom conservative management is sufficient 1.
- Diagnostic considerations include testicular torsion, torsion of testicular appendage, epididymoorchitis, epididymitis, idiopathic scrotal edema, hydrocele, inflammation of the tunica vaginalis, trauma, testicular tumors, epididymal cysts, Fournier gangrene, scrotal abscess, and strangulated inguinal hernia 1.
From the Research
Emergency Room Precautions for Male Genital Concerns
- The emergency room precautions for male genital concerns vary depending on the specific condition, such as epididymitis, orchitis, or external genital injuries 2, 3, 4, 5.
- For epididymitis and orchitis, typical physical findings include a swollen, tender epididymis or testis located in the normal anatomic position with an intact ipsilateral cremasteric reflex 2.
- Laboratory studies, including urethral Gram stain, urinalysis and culture, and polymerase chain reaction assay for C. trachomatis and N. gonorrhoeae, help guide therapy for epididymitis and orchitis 2.
- Initial outpatient therapy for epididymitis and orchitis is empirical and targets the most common pathogens, such as Chlamydia trachomatis and Neisseria gonorrhoeae in men between 14 and 35 years of age 2, 4.
- For external male genital injuries, the diagnostic procedure classically consists of taking a history and inspecting the wound, which provides enough diagnostic information for the correct choice of conservative or surgical treatment 3, 5.
- In cases of penile emergencies, such as ischemic priapism, paraphimosis, and entrapment injury, emergency practitioners must be concerned with the entities that, if left untreated, can result in ischemia and necrosis of the penis 6.
- Any penile trauma should be considered an emergency until proven otherwise, and the correct therapeutic approach is crucial for preserving fertility and penile erection 3, 5, 6.