Hey guys, Rena Malik, Urologist, and Pelvic Surgeon. Today I'm reacting to another episode
of Grey's Anatomy and you've seen a bunch of these from me before which I thought were
pretty good. There was one where I reacted to Mark Sloane getting a penile fracture.
Hh my God are you okay? No!
One with a guy who stuck his penis into a bee's or hornet's nest.
did you put your penis in a hornet's nest? No
Maybe, Yes!
Another one where a guy gets a penis transplant,
Ryan could you show everybody what we're here to do today
And a woman gets a stem cell bladder transplant
Take your time honey I want to see this bladder you think oh look at that
So make sure you check those out and I hope you guys enjoyed today's episode as
well if you like what you see make sure you subscribe and give me a thumbs up
is it a big surprise it's very big well I need to use two hands your hands won't be enough
dr webber does this bed go down at all brian um this is the urologist that i was talking
to you about this is dr catherine avery um before you say anything uh
no these are basketballs in my pocket soon yes i am very happy to see you
all right so that is one large scrotum and to be quite honest we don't see these sorts of things in
this size the way they're showing it in grey's anatomy very often at all but there's a lot of
different things that can cause scrotal tissue to get enlarged and i'll go through a few of them one
can be a hydrocele which is when you develop a fluid filled sac around the testicle that can
make it larger another can be a hernia which is when you have a weakness in the abdominal muscles
and that can allow a piece of intestine or your bowels to fall into what's called the inguinal
canal and that can actually drop into the scrotum so you can actually have small intestine fall
into the scrotum causing a hernia another thing that you can have which is a little bit less
common is called hydratingitis and that's when you have an inflammatory skin condition that can
cause these lumps to form underneath the skin and that can often happen in the groin and also
extend to the scrotum lastly what you can see is scrotal lymphedema we see this much more commonly
in people in tropical countries because they can get parasitic infections that cause this
but we do see it in the united states as well most often caused due to radiation a prior surgery that
could disrupt the lymph nodes in that area or it could be iatrogenic meaning that we don't really
know why it's happening so let's find out what this guy has i don't understand why you've let it
get this bad before seeking treatment he's using it as an excuse to avoid our 10-year high school
paula i am not yes it wasn't this bad before i mean i i've seen other doctors who prescribe
pills that never seem to work then a few months ago everything sort of just
blew up he wouldn't even come if i hadn't dragged him i would have when
after the reunion brian there's no need to fear
by the time we get finished with you you'll be hidden that reunion with 98 less scrotum
i wouldn't go that far yeah so a lot of people actually delay seeing the urologist because
they're embarrassed and i see it all the time for things that involve patients genitals in fact
there was a story about a gentleman a few years ago i think it was in 2018 or 2019 named wesley
warren and he was having insurance issues also bounced from doctor to doctor and was actually
carrying around 132 scrotum in his pants and there was actually a lot of media attention surrounding
this and you could actually see him walking around with um wearing like a sweatshirt around his
scrotum and and also just dealing with that for i think it was five years before he finally got
to a urologist who could help him which is really really sad because that's i mean five years living
that's gotta be so uncomfortable and so painful they actually even made a documentary about it
on tlc called the man with the 10 stone testicles and 10 stones is actually equivalent to 140 pounds
and so that's a lot of weight to be carrying in between your legs i still don't understand
what it is i'm looking at those are testicles dr kepner don't worry sweetheart they're not
supposed to look like that so typically for something like this a physical exam is very
valuable and sometimes you'll do an ultrasound as well to make sure you can identify what exactly
the cause of the problem is if you think it's a lymphatic problem some people will get specialized
lymphatic drainage studies to assess where exactly the problem is where the lymph nodes are not
draining but most of the time an examination as well as an ultrasound is what you get you
may get a ct scan which is what they're showing here to assess if this is a hernia or there's any
other abdominal pathology that might be causing this i can't see anything you described them as
so big a sheet couldn't cover them i may have exaggerated okay ladies this isn't a side show
gentlemen step right up
so inappropriate that's it
okay that's not okay oh great Karev's here to make us all
laugh with funny jokes about my hands on a man's parts this isn't funny that poor guy
i know can you imagine becoming so swollen that a surgeon needs to use a scalpel to dig
out all that excess tissue until the testicles and cords hit the open-air
I mean who even knows what happened to his penis and all that mess that's not okay
nice your mother won't stop asking me why I look so tired why do you look so tired
they look so cute together shut up I think they look tired go to hell okay so first and foremost
super inappropriate to be joking about a patient outside their room like that and to discuss
something like that in such a kind of crude fashion this guy truly is suffering and he
should not be a sideshow for residents to kind of joke about behind that patient's back so just a
little back story April and Jackson are hooking up as well as Richard and Catherine Avery and
neither of them know and Jackson and Catherine are mother and son and so really interesting dynamic
that goes on in the episode, of course, they have to add drama to it because it's grey's anatomy but
overall I will tell you that if you are suffering from a genital problem be reassured that we don't
joke about these things behind your back we take it very very seriously and we want to help you
we need to identify the testicles in the cords
don't want to damage them yes ma'am I'll keep my eyes peeled I'm having the best time
forceps what's with the face I'm not making a face I've spent a few thousand hours looking
at you with a mask on I know when you're making a face bailey I'm not making a face just so you
know I did not bully April Kepner to given up the surgery she approached me so nuts to her
get it nuts to her oh come on you get it I'm a urologist dr bailey, of course, thank you
hey I spend most of my day in the bowel doesn't mean I don't laugh or fart
tough room ooh the tension in that o.r this operating room is not a typical operating room
in the sense that there are two general surgeons operating with the urologist very typically it
is just a urologist with whoever their assistant is whether that's a resident in this case would
probably be a resident or a fellow and there may be a plastic surgeon available as well to help
if you need a skin graft sometimes the skin is so poorly debilitated after having this sort of
problem that you actually need to graft some of skin onto that area to help it heal appropriately
this guy has scrotal lymphedema which they do kind of allude to in the episode and scrotal lymphedema
like i said most commonly is due to radiation previous surgery or sometimes we just don't
have a cause for it a lot of times these guys are bounced around from urologist urologists getting
antibiotics or just being told to lose weight and that will help but it doesn't typically help
typically you need to have surgery in order to remove the excess tissue and sometimes you can
even do micro surgical repair to get the lymphatic vessels back together to help the drainage as well
so why does scrotal lymphedema happen well it's because there is a problem with your lymphatic
system and your lymphatic system is a bunch of vessels that are throughout your entire body
that function to help take some of this excess fluid that your body makes and recirculate it back
into the body and when there's a deficiency in that system you can have what's called lymphedema
or swelling so you'll often find that people who've had surgery that destroys the lymphatic
system can develop lymphedema because the surgery has disrupted the ability for the lymphatics to
take that fluid out of their body and recirculate it also if you've had radiation it can cause
fibrosis to those lymphatic vessels which can make it difficult then again to get that fluid
reabsorbed and lastly in people who are morbidly obese or very overweight you can have incompetence
of the valves in the lymphatic system so you can imagine that the lymphatic system has to go
against gravity because it's taking fluid from all over your body including your feet your groin and
all the way back up to your heart and so it has to work against gravity so there's valves that help
from preventing it from going backwards towards gravity when you need to get it back up good news
brian procedure went as planned amy miller's got a lot to look forward to you know it's
really not uh amy paul and i have been friends for so long i never really know how to say it
son uh it's none of my business but I don't think you ought to be ashamed of your feelings
seems to me we just surgically removed the only thing you had to be embarrassed about hey
there's a whole lot less of you under that blanket
would you mind
of course, they have to end on a high note so typically after surgery there's a
about a two week period where they'll have you on some sort of bed rest to allow that area to
heal or at least very limited restrictions and then up to six weeks no heavy lifting
no strenuous activities so I think that they always show this rosy picture everyone comes
out of surgery like ready feeling great and typically you know there is a recovery time and
there's pain and you don't always feel and look so great right after surgery so that's it for today
thank you so much for watching as always remember to take care of yourself because you're worth it