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The Enlightenment
Published in Scott M. Jackson, Skin Disease and the History of Dermatology, 2023
The other major development in the history of occupational dermatology took place in London when in 1775, English surgeon Percival Pott (1714–1788) determined that chimney soot causes scrotal cancer. Pott wrote in his Chirurgical Observations: There is a disease as peculiar to a certain set of people, which has not, at least to my knowledge, been publicly noticed; I mean the chimney sweeper's cancer. It is a disease which always makes its first attack on, and its first appearance in, the inferior part of the scrotum; where it produces a superficial, painful, ragged, ill-looking sore, with hard and rising edges: the trade call it the soot-wart….In no great length of time, it pervades the skin, dartos, and membranes of the scrotum, and seizes the testicle, which it enlarges, hardens, and renders truly and thoroughly distempered; from whence it makes its way up the spermatic process into the abdomen, most frequently indurating and spoiling the inguinal glands: when arrived within the abdomen, it affects some of the viscera, and then very soon becomes painfully destructive. The fate of these people seems singularly hard: in their early infancy, they are most frequently treated with great brutality, and almost starved with cold and hunger; they are thrust up narrow, and sometimes hot chimnies, where they are bruised, burned, and almost suffocated; and when they get to puberty, become peculiarly liable to a most noisome, painful and fatal disease.88
Physical Aspects of the Sex Response
Published in Philipa A Brough, Margaret Denman, Introduction to Psychosexual Medicine, 2019
In males, accompanying genital manifestations of arousal include thickening and contraction of the dartos muscle of the scrotum, which results in elevation of the testes, as previously listed. There may be an accompanying emission of pre-ejaculatory fluid, also known as pre-seminal or Cowper's fluid (12). This is a clear, semi-viscous alkaline fluid produced mainly by the bulbourethral (Cowper's) glands and mucus-secreting (Littre's) urethral glands. The volume of emitted pre-ejaculatory fluid ranges from 0 to 5 mL (13). This fluid assists lubrication and neutralises any acidic urine in the urethral lumen, which would otherwise be hostile to sperm in the subsequently definitive ejaculate. It should be noted that the fluid may contain viable spermatozoa, which may have contraceptive ramifications.
Scrotal bullet
Published in Alisa McQueen, S. Margaret Paik, Pediatric Emergency Medicine: Illustrated Clinical Cases, 2018
Penetrating wounds to the lower abdomen, pelvis, penis, rectum, and upper thighs may involve the scrotum due to anatomical proximity. GSWs to the lower extremities are commonly associated with scrotal wounds. A thorough examination to determine entrance and exit wounds in addition to careful inspection of the scrotal skin for lacerations and ecchymosis is necessary. Any penetrating trauma through the dartos layer has a high association of testicular injury. Significant pain with marked edema localized to the testicle or scrotum requires early surgical consultation. Assess the testicular lie and tenderness, the cremasteric reflex, and quality of the femoral artery pulses. The presence of a hematocele (blood within the tunica vaginalis but outside of the tunica albuginea) is concerning for a testicular rupture and ultrasound is recommended. Scrotal edema/ecchymosis may also be caused by blood tracking from an intra-abdominal injury through a patent processus vaginalis.
Unsatisfactory testicular position after inguinal orchidopexy: Is there a role for upfront laparoscopy?
Published in Arab Journal of Urology, 2020
Ahmed Abdelhaseeb Youssef, Mahmoud Marei Marei, Mohamed Hamed Abouelfadl, Wesam Mohamed Mahmoud, Atef Salaheldin Abdulaziz Elbarawy, Tamer Yassin Mohamed Yassin
The previous transverse lower inguinal crease incision was then used to gain access to the inguinal area. The incision was deepened to the external oblique aponeurosis with care, as the testis may be found in the superficial inguinal pouch. If so, the testis was freed from the external oblique aponeurosis. When the testis was proximal to the superficial (external) inguinal ring, it appeared after opening the aponeurosis. The cord was identified and then dissected free from the floor of the canal. The dissection was carried out to the deep inguinal ring; upon reaching this level, a characteristic give was noted, i.e. elongation or release of the vessels as a result of the initial laparoscopic dissection (Figure 3). In all cases, the gained length allowed the testis to reach the scrotum easily (Figure 4). Once an adequate length has been achieved, fixation of the testis to the scrotum was accomplished within a sub-dartos pouch, additionally using absorbable sutures at three points. The scrotum was then closed. The port sites and the inguinal incision were standardly closed in layers.
The importance of the clinical examination of the lower sacral segments: Four case reports
Published in The Journal of Spinal Cord Medicine, 2019
Maria João Andrade, Tiago Felix Soares
The problem lies in patients with urological symptoms that may have a neurological cause. So, for a person with unexplained bladder dysfunction, we must perform a neuro-urological examination, testing the integrity of the sacral segments and, in male, testing the dartos reflex (T12-L2 spinal level).5,6 The dartos muscle is a sympathetically innervated dermal muscle layer within the scrotum, distinct from the somatically innervated cremaster muscle. We elicit the dartos reflex by cutaneous stimulation of the thigh, which produces a slow, writhing, vermicular contraction of the scrotal skin. This reflex can be used to evaluate the thoracolumbar sympathetic and genitofemoral nerve pathway. If it is abnormal, this points to a sympathetic lesion. In men and women, a patulous anus suggests a loss of both striated and smooth sphincter tone.3 Dartos and anal reflexes must be tested bilaterally.6 In women, the muscular strength of the pelvic floor muscles should also be assessed.8,9
Twin penile skin flap, is it the answer for repair of long anterior urethral strictures?
Published in Arab Journal of Urology, 2018
Diaaeldin Mostafa, Hisham Elshawaf, M. Kotb, Abdelwahab Elkassaby
The operation was performed under general anaesthesia, with the patient in standard lithotomy. Penile hair is not shaved until the hair line is marked to ensure that the harvested flaps are of non-hirsute skin. After sterilisation and draping, under anaesthesia we spare a 3-cm width of ventral skin and try to approximate lateral skin virtual lines of incisions using non-toothed forceps. If it is not under tension we proceed. The urethral meatus is inspected and calibrated. A Nelaton catheter 16–20 F is introduced until the distal end of the stenosed segment. A ventral longitudinal penile skin incision is made along the estimated stricture site (Fig. 1). The fascia dartos is incised and dissected down to the urethra. Another perineal incision is made to expose the bulbar urethra.