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INTRODUCTION

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This chapter reviews the common acute infectious and structural or anatomic GU disorders. There are five GU emergencies: testicular torsion, Fournier's gangrene, paraphimosis, priapism, and significant GU trauma (see chapter 265, "Genitourinary Trauma"). Related emergencies include strangulated inguinal hernia (see chapter 84, "Hernias") and ruptured abdominal aortic aneurysm (see chapter 60, "Aneurysmal Disease"), which may present with scrotal pain.

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ANATOMY

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PENIS

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Three cylindrical bodies—the corpus spongiosum, which surrounds the urethra, and the paired corpora cavernosa—form the shaft of the penis (Figure 93-1). The corpora cavernosa are the major erectile bodies, extending distally from the pubic rami and capped by the glans penis. These cylindrical structures are encased in a thick tunic of dense connective tissue, the tunica albuginea. External to the tunica albuginea is Buck's fascia, which fuses with Colles' fascia at the level of the urogenital diaphragm. The internal pudendal artery provides the blood supply, which branches to form the deep and superficial penile arteries. Lymphatics drain from the penis into the deep and superficial inguinal nodes.

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SCROTUM

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The prepubertal scrotal skin is thin and thickens with subsequent hormonal stimulation during puberty. Immediately beneath the skin are the smooth muscle and elastic tissue layers of Dartos' fascia, similar to the superficial fatty layer (Camper's fascia) of the abdominal wall. The deep membranous layer (Scarpa's fascia) of the abdominal wall extends into the perineum, where it is referred to as Colles' fascia, and forms part of the scrotal wall (Figure 93-2). The blood supply is derived primarily from branches of the femoral and internal pudendal arteries. Lymphatics from the scrotum drain into the inguinal and femoral nodes.

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FIGURE 93-2.

Anatomy of the scrotum and the testis. a. = artery; v. = vein.

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TESTES

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The testes average in size between 4 and 5 cm in length and 3 cm in width and depth, and usually lie in an upright position, with the superior portion tipped slightly forward and outward. Each testis is encased in a thick fibrous tunica albuginea except posterolaterally, where it is in tight apposition with the epididymis. The enveloping tunica vaginalis covers the anterior and lateral aspects of the testes and attaches to the posterior scrotal wall. Superiorly, the testes are suspended from the spermatic cord; inferiorly, the testis is anchored to the scrotum by the scrotal ligament (gubernaculum). Maldevelopment with lack of firm posterior fixation of the tunica vaginalis leaves the testes and epididymis at risk for torsion about the spermatic cord. The posterior (visceral) leaf of the tunica vaginalis is adherent with the tunica albuginea of the anterior testicular ...

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