BACKGROUND:

The effect of cocaine at the testicular level is indirectly due to an ischemic process resulting from the blocking of neurotransmitter reuptake, which leads to local vasoconstriction. Cocaine users may be prone to present with repeated episodes of spermatic cord ischemia, causing chronic vascular damage. Symptoms of acute scrotum can result in irreversible acute vascular damage.

CLINICAL CASE:

A 58-year-old man arrived at the emergency service due to pain of sudden onset at the left testicular region after having inhaled cocaine. He had a personal history of cocaine addiction since the age of 20 years and a medical history of high blood pressure of one-year progression, with no current treatment. Urologic examination: with the patient standing on both feet, testicular erythema, scrotum with edema, and ascended testis with a horizontal lie were observed. Palpation was painful, the epididymis was enlarged and in the anterior position, and there was no cremasteric reflex or testicular “blue dot” sign. Ultrasound study: left testis measuring 4 cm, with heterogeneous echogenicity, a fibrous thickened epididymis (thickening of 3.5 cm) with numerous testicular and scrotal wall adhesions, and hydrocele of approximately 40 cc. The patient was classified as high-risk on the TWIST scale and so immediate surgical examination was carried out, revealing a non-viable spermatic cord. Left orchiectomy was performed as definitive treatment, and postoperative progression was satisfactory.

CONCLUSION:

The evaluation of a history of cocaine use in patients with metabolic syndrome is important, given that it can be a decisive factor in the appearance of acute scrotum.

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