Massive Scrotal and Penile Edema Mimicking an Acute Urological Emergency: A Report of Two Cases

# Background Acute scrotal and penile swelling may mimic surgical urological emergencies such as torsion or Fournier's gangrene but can also reflect systemic fluid overload. # Case Presentation We report two cases of severe scrotal and penile edema related to decompensated heart failure and nephrotic syndrome, both initially referred as acute scrotum. The index patient with heart failure was a 68-year-old male with ischemic cardiomyopathy, with a low ejection fraction of 20% in addition to generalized anasarca, with progressing bilateral scrotal and penile edema over 72 hours. The second patient, a 42-year-old male, with a diagnosis of focal glomerulosclerosis, nephrotic syndrome, with low albumin of 1.8g/dL, along with heavy proteinuria for two weeks, associated with severe scrotal edema Investigations: Both cases showed marked genital swelling without evidence of infection and/or torsion. Scrotal ultrasound with Color Doppler studies demonstrated soft-tissue edema with intact testicular parenchyma and vascularity, excluding testicular torsion, necrotizing infections, and lymphedema. Laboratory data also established that both cases were due to associated chronic conditions, that is, BNP and cardiorenal syndrome in Case 1, and marked hypoalbuminemia with proteinuria in Case 2. Management and Outcome: Targeted medical optimization of the underlying disease led to complete resolution without surgical intervention. Case 1 showed 70% reduction in genital swelling after five days of cardiac optimization and cautious diuresis. Case 2 achieved near-complete resolution after seven days of intravenous albumin, aggressive diuresis, and immunosuppressive therapy. # Conclusion Recognizing this pattern can prevent unnecessary scrotal surgery and refocus management on timely treatment of the systemic condition. Scrotal ultrasound with Doppler is invaluable in distinguishing systemic genital edema from surgical emergencies.