AboutArthur Goldstein, M.D. Expertise Any problems or questions related to the field of urology; ie urinary stone disease, urinary cancers (kidney, bladder, prostate, testis, etc.), urinary infections, impotency, etc.
Experience I am retired from the active practice of urology. My 34 years was totally in the clinical field and involved the entire gamut of genitourinary problems, with special interest in male impotence and endourology.
Organizations American Medical Association, American Urological Association, American College of Surgeons
Question Hello Dr. Goldstein: I am a 44 year old male named Kevin. This Question Posted in Jan 2009 "Can you die from a scrotal abscess, even if it has been cut opened and drained and you are being treated with antibiotics, and the doctor keeps taking you into surgery to cut infected tissue out?" Is identical to what I have been going through for the past two years. I have had 3 surgeries and I am heading in for another. The first two surgeries my scrotum was opened up and the abscess was drained and was packed until healed. The third surgery the Urologist removed all of the scarred tissue and closed it up. Everything was great for four months and now the infection came back. My scrotum continues to erupt and drain even while on Augmentin. I am currently on Augmentin 500mg PO QD until my next surgery. They have tried various antibiotics. They seem to work at first and then the infection comes back and finds its tract to drain from my scrotum. Every time the infection comes back my ear drains a dark brown fluid. I have been to two urologists and two infectious disease specialists and they all seem baffled and always seem to dismiss my comment about the ear. Have you ever heard of this connection? Could the ear infection be causing the scrotal abscess? I also heard of a case where the patient suffered from recurring scrotal abscesses and actually had Mucoepidermoid Lung Tumors. When I looked up Mucoepidermoid Lung Tumors online it also mentioned the ear tract drainage. I know that I am probably reaching for answers, but any input is appreciated. What are your thoughts? Kevin
Answer Kevin, I have seen many cases of scrotal abscess and no one in my practice has ever died from them. In none of these cases has there been associated ear drainage. Because of your question I did look up mucoepidermoid lung cancer and there was one case report of recurring scrotal lesions that appeared to be abscesses. On histologic exam, however, the excised "abscess" was found to be from the lung tumor. Since you has the abscess excised on one occasion, it would be normal routine for the pathology lab to analyze the tissues and I assume they showed no tumor. I was unable to locate the case associated with ear drainange but will take your word for this.
In my experience, scrotal abscess come either from sebaceous cysts or from de nuovo inoculation of the scrotum with bacteria often of the Staphylococcal species. Let me explain these to you. Sebaceous glands are a special type of sweat gland that are prominent in the genital region. Not infrequently, the duct that drains their secretions to the skin surface can become blocked. If this happens, the fluid builds up and they begin to swell. Sebaceous cysts are very common and generally of no consequence. If large and unsightly, they are sometimes excised for cosmetic reasons. On occasion, these glands may becomes infected. The most common cause of infection is trying to squeeze the mass and, therefore, this should not be done. In fact, squeezing an inflamed mass may spread infection to other parts of the body which can be very serious. If infected, they become red, more swollen and tender. In this case, one should see a physician for possible incision and drainage. This is a minor procedure that usually can be done in a few minutes the office. If the infections are recurrent, the sebaceous gland should be excised once the site is completely healed to prevent further recurrences.
Skin abscesses (boils, furuncles) are common and can occur anywhere but often in areas where there is moisture (sweat). They are most common under the arms and on the genitalia. They often arise in sweat glands, are recurrent and are called hidroadenitis suppurativa. The infection is due to bacteria, most commonly Staphylococcus aureus. A virulent & resistant strain of this germ prominent today is MERSA (methicillin resistant Staph aureus). This bacteria is frequently found in hospitals, nursing homes & health clubs. I am sure that you have had your drainage cultured several times and the infectious disease expert should be the one discuss the bacteria causing your problem and also to advise you on which antibiotics might help to prevent recurrences. Other than this, the treatment is as you have undergone; drainage of abscesses and then excision of damaged tissues that might serve as a reservoir for recurrences. Frequent and meticulous hand washing & daily showering on your part are essential. Your doctors are rendering standard and appropriate treatment. Sorry that I have no further suggestions. Good luck.
