Male lower genitourinary tract emergencies: The gamut of prostatic, penile and scrotal pathophysiology and cross-sectional imaging findings.
Williams P, Starcevic V, Rheinboldt M, and Proposto Z. Male lower genitourinary tract emergencies: The gamut of prostatic, penile and scrotal pathophysiology and cross-sectional imaging findings. Emerg Radiol 2018; 25(5):593.
Learning Objectives To review the pathophysiology and imaging manifestations of acute scrotal and penile emergent vascular, inflammatory and traumatic conditions To discuss sonographic, CT, andMR imaging techniques in relation to the various clinical scenarios as well as pitfalls and differential diagnostic considerations Background Primarily vascular, infectious or traumatic in etiology, male external genitourinary emergencies often necessitate expeditious diagnosis in order to preserve clinical function. Sonography is primarily used for diagnosis of infectious conditions such as epididymitis/orchitis as well as for traumatic injury. MRI however may be a useful adjunct in problematic cases of suspected penile or testes fracture. A low threshold should be maintained for performing retrograde urethography to avoid exacerbation by blind Foley placement. Fournier's gangrene necessitates MDCT to assay disease extent and optimize surgical planning. Vascular pathologies including torsion, and priapism are well characterized by Doppler ultrasound, while MRI may be a useful adjunct in confirming segmental testicular infarcts. Content Introduction Scrotal emergencies-sonographic and MR imaging pearls, anatomic features-trauma: sonographic features and sensitivity metrics, MRI as adjunct, salvage assessment-infection: epididimyitis/orchitis pyocele abscess scrotal cellulitis, Fourniers, early sonographic features, early and late extension, MDCT illustrations and pathways of extent-vascular: torsion, pitfalls, metrics, testicular infarcts, varicoceles, appendigeal torsion, Penile emergencies-trauma fractures, ultrasound and MRI, urethral injury, classification, mimics-vascular high and low flow priapism, Mondors-infection balanitis fourniers mimics-anasarca and calciphylaxis Summary Summary External genitourinary emergencies include a wide gamut of traumatic, infectious and ischemic conditions, many of which constitute a urologic emergency in order to decrease morbidity and mortality and to maintain functional viability. Familiarity with the characteristic multimodality imaging features and diagnostic workup will enable a timely diagnosis and help expedite appropriate clinical care.