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An Evidence-Based Approach To Male Urogenital Emergencies

February 2009

Abstract

Acute scrotal or penile pain can cause a high level of anxiety for the patient, parent, and even, at times, for the health care provider. Presentations are often delayed as a result of the patient's embarrassment, and the patient may not be initially forthright with the exact nature of the complaint. The care provider must be sensitive to both the emotional and physical needs of the patient.

The challenge in emergency practice is to differentiate conditions requiring prompt evaluation and action from urgent conditions that are amenable to outpatient management. Missed or delayed diagnosis of testicular torsion threatens testicular viability and future fertility. Similarly, early identification and aggressive management of necrotizing fasciitis of the perineum (Fournier's disease or Fournier's gangrene) is critical to maximizing outcomes. Emergent penile conditions include priapism and paraphimosis. Any form of GU trauma is presumed to be an emergency until proven otherwise.

The goal of this issue of Emergency Medicine Practice is to provide a risk management tool and to provide an evidence-based best practice approach to the male complaining of acute scrotal or penile pain.
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