Male genital problems may be the cause of significant morbidity.
One of the most anxiety-provoking problems presenting to an ED is
the male with acute genital discomfort. Furthermore, the extensive
sensory innervations of the genital area with common final sensory
afferent pathways in the male account for the common association
of abdominal pain with some acute genital disorders. Approximately
10% of all traumatic conditions presenting to the ED involve
the genital system—of that, only 2% involve the
genital system exclusively.1 Life-threatening GU
conditions, such as Fournier gangrene, remain relatively rare.
This chapter reviews some of the common acute infectious and
structural or anatomic genital disorders.
The penis is composed of three cylindrical bodies: the corpus
spongiosum, which surrounds the urethra, and the two corpora cavernosa, which
form the main bulk of the penis (Figure 96-1).
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. All three cylinders are collectively
covered by a thinner fascia, Buck 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.
Cross-section of the penis.
The prepubertal scrotal skin is thin and thickens with subsequent
hormonal stimulation. Immediately beneath the skin are the smooth
muscle and elastic tissue layers of Dartos fascia, similar to the
superficial fatty layer (Camper fascia) of the abdominal wall. The
deep membranous layer (Scarpa 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 96-2).
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.
Anatomy of the scrotum and the testis. a. = artery;
v. = vein.
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