A scrotal abscess is a suppurative mass with surrounding erythema involving the superficial layers of the scrotal wall. The usual history given is progressive swelling of a small pustule or papule with increasing pain and induration or fluctuance. Constitutional symptoms and fever are generally absent.
Management and Disposition
For superficial scrotal abscesses of a cutaneous origin, use local anesthesia and simply make a stab incision and drain the abscess using the same technique as for incision and drainage elsewhere. Instruct the patient to use a sitz bath and to change the dressing frequently. Postdrainage antibiotics are not usually indicated. Immunocompromised patients may require IV antibiotics and admission. For more complex abscesses or abscesses thought to be secondary to epididymo-orchitis or associated with Fournier gangrene, consult urology.
If the patient appears ill out of proportion to the superficial appearance, suspect that this mass is the point of a deep scrotal abscess or Fournier gangrene.
Scrotal Abscess. Suppurative mass on the scrotum. (Photo contributor: David Effron, MD.)
Scrotal Abscess. A chronic recurring abscess with intermittent drainage in a patient with diabetes. (Photo contributor: Kevin J. Knoop, MD, MS.)