Erysipelas and elephantiasis of the scrotum--surgery and drug therapy

A Case Study of a Rapidly Progressive Cellulitis of the Penis and Scrotum in a Two-Month-Old Infant

A two-month-old infant presented with rapidly progressive cellulitis of the penis and scrotum without a history of trauma, circumcision, or previous infection. After multiple failed antibiotic regimens covering common pathogens associated with cellulitis, a combination of ceftazidime and clindamycin was used to treat his infection. The previous evidence of anaerobic bacteria being implicated in male genitourinary infections and the antibiotic course necessary in this patient's treatment indicate that infantile scrotal cellulitis could require a distinct approach from typical skin and soft tissue infections.

Management of acute scrotum in children--the impact of Doppler ultrasound

BACKGROUND

Investigation of the value of scrotal Doppler ultrasound (DUS) in the diagnosis of acute scrotum and its impact on the treatment strategy was undertaken.

METHOD

Seventy-nine children (mean age, 9.2 years) with acute scrotum were prospectively studied. The protocol included history, clinical examination, scrotal DUS, and standard laboratory analysis. Depending on scrotal DUS findings, the children were treated either nonoperatively (normal or increased testicular blood flow) or surgically (reduced or absent testicular blood flow). A follow-up investigation 6 weeks after discharge included a scrotal DUS.

RESULTS

In 66 children (84%), the result of DUS determined the management; 26 children with hyperperfusion (epididymitis and orchitis), 18 children with appendix testis torsion (ATT), and 9 children with normal perfusion (edema and hematoma) were treated nonoperatively. The follow-up examination revealed no testicular atrophy and confirmed the primary diagnosis. Ten children without testicular perfusion and suspected torsion and 3 children with orchitis and pyocele were surgically explored, and again, the initial DUS diagnosis was verified. In the remaining 13 patients (16%), the result of the ultrasound examination was unclear. Of these, 6 children were noncompliant and refused to undergo ultrasonography. Another 4 children were explored because of persistence of symptoms. In 3 additional patients, a testicular tumor was suspected. All these 13 children underwent surgical exploration, revealing inflammation (epididymitis) in 6 children and acute ATT in 4 children, whereas the suspected tumor emerged as postacute ATT in 3 boys.

CONCLUSION

In 84% of children with acute scrotal pain, the DUS was able to differentiate between surgical emergencies and other etiologies. In 16% of our pediatric patients, the DUS remained unclear, thereby necessitating surgical exploration.

Lymphœdèmes pénoscrotaux : étude rétrospective de 33 cas

INTRODUCTION

The aim of this retrospective study was to describe the main characteristics and treatment of male external genitalia lymphedema.

PATIENTS AND METHODS

From 1987 to 2003, all patients seen in a single hospital for lymphedema of male external genitalia were included. For each patient, the following characteristics were recorded: primary or secondary lymphedema, cause of secondary form, date of onset of lymphedema, associated lower limb lymphedema, clinical signs, and complications. In the primary forms, lower limb lymphoscintigraphy was performed. Specific surgery was proposed in all cases of symptomatic lymphedema (circumcision, scrotum and/or penile cutaneous excision).

RESULTS

Thirty-three patients with lymphedema of external genitalia (17 primary, 16 secondary) were recruited. Two primary lymphedema were congenital, one isolated. Mean age +/- SD of the onset of the 15 other primary genital lymphedema was 23.4 +/- 17.5 years, always after the appearance of lower limb lymphedema. Sixteen men had secondary lymphedema (bladder, prostate, or rectum cancer, Hodgkin or non-Hodgkin lymphoma, aorto-bifemoral bypass grafting, biopsy or curretage of inguinal nodes). Secondary genitalia lymphedema was not associated with lower limb lymphedema in two cases and, in the others it occurred 66 +/- 122 months after (n=11), at the same time (n=2) or before lower limb lymphedema (n=1). Clinically, we noted genitalia heaviness (n=31), lower limb lymphedema (n=30), vaginal hydrocele (n=13), impaired miction due to prepucial swelling (n=10), leakage of lymphatic fluid (n=10). Lower limb lymphedema was complicated by at least one erysipelas (n=20), spreading to the external genitalia (n=4). In primary forms, lymphoscintigraphy showed ipsilateral hypoplasia of inguinal nodes in lower limb lymphedema (n=14) and/or external genitalia backflow (n=7). Surgical treatment was performed in 17 cases (11 primary, 6 secondary) with good results after 21 months' median follow up (1 month-10 years). Two patients died of cancer. One secondary lymphedema improved spontaneously and one disappeared after withdrawal of lower limb pneumatic compression.

DISCUSSION

Lymphedema of external genitalia is responsible for discomfort and local complications. Surgical treatment is the main procedure of this disorder.