Middle-aged patients: Scrotal ventilation, prevention of urinary tract infections, and pheochromocytoma

**113. Why should the scrotum be allowed to breathe?**

With the arrival of summer, scrotal eczema once again becomes a major enemy for men.

Scrotal eczema is the most common type of eczema, generally limited to the scrotum and surrounding area. The scrotal skin initially becomes red and swollen, with intense itching, and numerous small blisters ranging in size from pinhead to rice grain appear. If you see similar symptoms, be alert; you may have scrotal eczema. Surveys show that over 86% of men suffer from scrotal eczema to varying degrees. When scrotal eczema (itching) occurs, the sweat glands of the scrotum become dysfunctional, resulting in excessive sweating. This not only makes underwear stick to the scrotum but also emits a distinctive odor. Furthermore, due to the sensitive nature of the scrotum, scratching is inconvenient in public places when the itching is unbearable; scratching through clothing is both ineffective and embarrassing, causing considerable discomfort. If scrotal eczema is left untreated, the fungus can spread to the groin and inner thighs, forming tinea cruris, which is extremely itchy and causes significant discomfort. In addition, the pathogens growing on the surface of scrotal eczema can enter the prostate gland through the urethra, causing recurrent prostatitis. It is clear that scrotal eczema should not be ignored; vigilance and strict prevention are necessary.

The reason for scrotal eczema is mostly due to poor ventilation and dampness in the scrotum, preventing heat from dissipating, especially in the hot summer months when the scrotum is easily soaked with sweat. This dampness allows a large number of pathogenic bacteria to thrive, leading to scrotal eczema. People who are obese, consume high-calorie diets, have frequent sexual activity, or sit for long periods (students, office workers, and drivers) are at high risk for scrotal eczema and should pay special attention to the following:

(1) Do not stay in hot and humid environments for a long time, and try not to sit for long periods of time while driving, studying or playing computer games.

(2) Keep your underwear dry and well-ventilated, and do not wear synthetic fiber underwear.

(3) Shower and change clothes as soon as possible after exercise, and try not to ride a bicycle for a long time.

(4) Avoid wearing thick, tight pants, especially jeans. When you get home, it's best to wear loose, breathable boxer shorts instead.

(5) Do not sleep on your stomach to avoid compressing the scrotum. If possible, sleep naked.

(6) If you find that your scrotum is itchy, don’t be embarrassed. You should go to a regular hospital for treatment as soon as possible and do not believe false advertisements.

(7) If you have scrotal eczema, do not scratch it, do not wash it with hot water, especially do not wash it with soapy water.

(8) Avoid spicy and other irritating foods and maintain a reasonable and balanced diet.

To avoid the discomfort of scrotal eczema, we need to allow the scrotum to breathe more.

**114. How to prevent urinary tract infections?**

Urinary tract infections (UTIs) are caused by direct invasion of bacteria (and in rare cases, fungi, protozoa, and viruses). Depending on the site of infection, they can be classified as pyelonephritis, cystitis, or urethritis; based on the presence or absence of functional or organic abnormalities in the urinary tract, they can be distinguished as complicated or uncomplicated UTIs; and based on the nature of the inflammation, they can be classified as acute or chronic UTIs.

Urinary tract infections (UTIs) cause significant discomfort and pain, including frequent urination, urgency, and painful urination, and may also lead to incontinence and urinary retention. Therefore, preventing UTIs is crucial.

(1) Wear loose-fitting, breathable, and moisture-wicking cotton underwear. Tight-fitting underwear made of synthetic fibers can easily cause symptoms such as frequent urination, urgency, and discomfort during urination due to local irritation.

(2) Develop a good habit of drinking more water. Drink at least 1000 ml (about two large cups) every day and keep the daily urine output between 1500 and 2000 ml. Give full play to the "flushing" effect of water on the urethra and prevent bacteria from staying and multiplying in the bladder.

(3) Pay attention to urinating as soon as you feel the urge. It is generally good to urinate once every 2 to 3 hours, and avoid the bad habit of holding in urine. Holding in urine can prolong the time that urine stays in the bladder, which is conducive to the growth and reproduction of bacteria. In addition, it will also increase the pressure in the bladder, making it easier for bacteria to ascend along the ureter and cause pyelonephritis.

(4) Maintain good hygiene habits and take regular showers. Shower instead of tub baths or pool baths. Wash the perineum every night, but avoid using soap. Soap is alkaline and can alter the acidic environment of the vagina, urethra, and surrounding areas, making urinary tract infections more likely.

**115. Why should pheochromocytoma be suspected in refractory hypertension?**

We have a patient in our ward, a man in his 40s, who often experiences dizziness, headaches, chest tightness, chest pain, palpitations, and blurred vision. He went to the internal medicine department and his blood pressure was measured at 200/110 mmHg. He was prescribed four kinds of antihypertensive drugs, but his blood pressure was still high. Later, a CT scan revealed that he had pheochromocytoma.

Pheochromocytomas originate from the adrenal medulla in the middle of the adrenal gland. The morphology of the medullary cells varies. They are named pheochromocytomas because the granules in these cells stain when treated with chromium-containing solutions. When pheochromocytomas develop, the tumor stores large amounts of adrenaline and noradrenaline, both of which are hormones with strong pressor effects. These are often unnoticed by the patient or others, but once stimulated, the tumor releases a significant amount of catecholamines, causing a sudden increase in blood pressure, cardiac arrhythmia, and potentially fatal shocks.

Pheochromocytoma is so dangerous that it is treated with great caution in clinical practice. According to literature reports, if two of the following five symptoms are present: abdominal mass, hypertension, diabetes, and elevated basal metabolic rate, pheochromocytoma should be suspected; if three are present, it is highly suspected; and if four are present, a diagnosis can be confirmed.

Pheochromocytomas are best removed via minimally invasive surgery, as they are mostly benign tumors with generally good postoperative outcomes. However, the surgery and anesthesia carry significant risks, especially with large tumors that are highly vascularized and closely attached to surrounding major blood vessels, making them prone to bleeding. The tumors also contain large amounts of catecholamines, which can be released into the bloodstream upon compression, causing a sharp rise in blood pressure and cardiac arrest. Therefore, thorough preoperative preparation and postoperative care are essential to improve surgical safety.

Don't underestimate the dangers of high blood pressure; if you experience similar symptoms, be vigilant.