Scrotal edema

• 28 Jul 2020 09:39:08 PM
• |General Urology

50 years old male with out any comorbidity, presented with swelling n edema of scrotam n penis of 2months duration.

Comments(4)

• 

  Pankaj N Maheshwari

  04 Aug 2020 07:27:11 AM

  Interesting case

  Common reasons for scrotal wall and penile edema are fluid overload (CCF, liver failure, venous obstruction) or lymphatic obstruction. 

  Any history of trauma or injury?

  What was the cause of retention of urine? What are DRE findings and PSA?

  Is he on any new drugs that could have caused allergic reactions?

  Why was Mero and Piptaz started? Were there features of sepsis/infection?

  I would also add fluid restriction, diuretics, alpha blockers (to remove catheter), scrotal support.

  Any thoughts and progress?

  Could consider CECT of abdomen and pelvis if it persists

  
  

• 

  Dr. Anil Takvani

  04 Aug 2020 07:43:28 AM

  I completely agree with Dr. Pankaj.

  Tikenjit; many questions raised,  please provide explanations. 

  
  

  I would have preferred SPC in place of per  urethral catheter in this case for retention of urine.

  Thanks.

• 

  Venugopal P

  04 Aug 2020 10:44:14 AM

  Dear All,

  Mazumdar has posted a case of considerable rarity. Since it has been existing for ~2 months duration, this cannot be classified as Acute Idiopathic Scrotal Oedema. Acute Idiopathic Scrotal Oedema is more frequent in Children and young adults and more rarely in older men. Whereas it is reverse in Chronic Idiopathic Scrotal Oedema.

  I am providing an article addressing ‘Ch Idiopathic Scrotal Oedema’ for your reading and understanding.

  https://benthamopen.com/contents/pdf/TODJ/TODJ-5-1.pdf 

  Though Mazumdar has looked for Chyle, it should be understood that Chyle is not a predominant feature with Filarial Scrotum. I would appreciate that the article by RK Shenoy from Alapuzha, Kerala is read by all to have an insight into Filarial Lymphoedema. Chertala, near Alapuzha was an endemic area for filaria and at one time almost all in Chertala had evidence of Filariasis.

  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2553332/pdf/kjp-46-119.pdf

  Ninan Chacko from CMC Vellore, as I remember, had brought out a Video demonstrating the ‘Filarial dance on US scrotum’ considered as a diagnostic sign if present. I am providing a link for ‘Filarial dance’ provided by Shalabh Bansal

  https://www.youtube.com/watch?v=ER1BFx4_qGc

  Christian from Chengelpet a long while ago found that Filarial Lymphoedema of legs and scrotum were more prevalent in those residing within 50 Kms of the coast while Chyluria was more in those residing over 50 Kms from coast. Chyluria was and even is more along the Gangetic Belt and VNP Tripathi from Varnasi had done extensive studies.

  As regards Chyluria, Rajaram (1968) from Chennai found that there was definitive block at Cisterna Chyli level by Lymphadenography but Philip David and P. Venugopal (1968) at Vellore could not demonstrate any block at Cisterna Chyli.

  I am sure these additional informations from the past could be help of understanding Filarial lymphoedema and Chyluria, both of these are now not as common as we used to see.

  With warm regards,

  Venu

   

• 

  Tikenjit Mazumdar

  04 Aug 2020 12:18:53 PM

  Thank u Maheswari sir, grateful...sir,he is government servant to be pricise...he had difficulty in passing urine not absolute AUR... patient is otherwise fit..no comorbidity...no dm...no htn...no any recent medication history...no trauma history..

  We thought may be some extravasation of urine..or may be fournier s gangren developing so we planned to divert the urine by SPC..but...his supra pubic region was completely edematous....SPC was not possible under local...so.. decided to dorsal slit...n catherization...it's done...but... Usg done... showing no pathology...ct not done...blood investigation r normal...urine test r normal...lft normal... problem.discharge on cath... swelling remains the same...so we started on DEC