1: Disorders Testes, Scrotum and Penis Flashcards
What are 6 differential diagnosis of testicular pain
- Testicular torsion
- Epidiymo-orchitis
- Hydatid of Morgagni
- fournire gangrene
- strangulated inguinal hernia
- renal stones
What is Hydatid of Morgagni
Testicular appendage
What age does hydatid of morgagni occur in
3-5 year-olds
what is a sign unique to hydatid or Morgagni
Blue discolouration of the scrotum
what is testicular appendage
remnant of the mullerian duct
how does strangulated inguinal hernia present clinically
- Recurrent inguinal-scrotal swelling
- Sudden-onset pain
what is testicular torsion
twisting of spermatic cord and its contents in the tunica vaginalis
what is the peak incidence of testicular torsion
15 -25 year-olds
aside from in adolescence, who may testicular torsion occur in
neonates (30d)
what type of torsion occurs in adolescents
Intra-vaginal (Within tunica vaginalis)
what are 4 RF for intra-vaginal torsion
- FH
- Previous torsion
- Cryptorchidism
- Bell clapper deformity
what is bell clapper deformity
Spermatic cord joins higher on tunica vaginalis. This increases mobility of the testes and often means they lie horizontally
what type of torsion is extra-vaginal torsion
Neonatal torsion
- Occurs as tunica vaginalis is not yet fully attached to the scrotum and therefore is susceptible to tort
how does testicular torsion present clinically
- Sudden-onset unilateral scrotal pain and swelling
how will the testes present on examination
Erythematous and swollen
what will be absent on testicular examination
Phren sign
Cremasteric reflex
what is phren sign
where testicular pain is relieved by lifting the testes
what is phren sign indicative of
epidiymo-orchitis
what time frame can necrosis of testes occur post-torsion
6-12h
how is testicular torsion diagnosed
clinically
how should testicular torsion be managed
emergency surgical exploration and bilateral orchidpexy
what is time frame for orchipexy
4-6h
what should all patients undergoing orchiopexy be consented for
Orchidectomy
what is epidiymitis
inflammation epididymis
what is orchiditis
inflammation testis
what is epididymo-orchitis
inflammation epididymis and testis.
explain epidemiology of epididymo-orchitis
orchitis rarely ever occurs alone. Most cases of epididymo-orchitis turn out to be epididymitis
when is the peak incidence of epididymo-orchitis
15-30 year-olds
60 year-olds
what causes epididymal-orchitis
STI
UTI
Gastroenteritis
what is the biggest cause of epididymal-orchitis in men under 35
STI:
- Chlamydia
- Gonorrhoea
what is the biggest cause of epididymal-orchitis in men over 35
UTI:
E.Coli
what causes just orchitis
Mumps
what are two complications of mumps
Testicular atrophy
Infertility
what is a risk factor or epididymal-orchitis
Unprotected sexual intercourse
Multiple partners
Bladder outlet obstruction
Instrumentation
Immunocompromised
how does epididymal-orchitis present clinically
Unilateral scrotal pain and swelling
Fever, riggers
Preceding dysuria or discharge
how does epididymal-orchitis present on examination
Tender, erythematous
what signs are positive in epididymal-orchitis
Phren
Cremasteric reflex
what is phren’s sign
Pain is relieved on elevating testes
what investigations should be ordered in epididymal-orchitis
NAAT on first void urine sample (Chlamydia and Gonorrhoea)
Urinalysis
how is epididymal-orchitis managed
Antibiotics
Analgesia
Bed-Rest
what antibiotic is given if suspected E.coli is cause of epididymal-orchitis
Oxafloxacin
what antibiotics are given if suspect STI as cause of epididymal-orchitis
Ceftriaxone and Doxycycline
what foes epididymal-orchitis increase risk of
Hydrocele
Abscess
how can scrotal swellings be divided
Extra-testicular
Intra-testicular
name 5 extra-testicular scrotal swellings
- Inguinal Hernia
- Hydrocele
- Epididymitis
- Epididymal cyst
- Varicocele
what age do epididymal cysts occur in
Middle-Age
how do epididymal cysts present clinically
Smooth fluctuant nodules above and separate to testis, may be multiple. Usually asymptomatic
what are features of epididymal cysts on examination
Transilluminable
what is one of the most common causes of scrotal pain in adults
epididymitis
what is a distinctive feature of inguinal hernias as a cause of scrotal swelling
cannot get above the swelling!
what can exacerbate scrotal swelling if an inguinal hernia
coughing
when may lump disappear if an inguinal hernia
lying down
what are 4 testicular lumps causing scrotal swellings
- Testicular cancer
- Torsion
how does testicular cancer present
painless irregular lump of testis
if suspecting testicular cancer describe investigations
- Testicular USS
- AFP, LDH and bHCG
do NOT, under no circumstances, biopsy! at this can seed the cancer
what is a varicocele
abnormal dilation of pampiniform plexus
what are the causes of varicocele
- Primary (Idiopathic)
- Secondary = lymphoma or RCC
what side do 90% of varicoceles occur on and why
Left
: left testicular vein drains into renal vein
how do varicoceles present clinically
Dull-ache sensation : worse on standing
Bag of worms - swelling that may disappear on lying down
what are 3 red flags of testicular varicocele
- Right sided
- Acute - onset
- Remains on lying flat
what does right sided testicular varicocele indicate
usually abdominal mass such as lymphoma or RCC
what should all individuals with varicocele be offered and why
abdominal exam - due to risk of RCC
what investigations are ordered in varicocele
USS
Semen analysis
why is a semen analysis offered in varicocele
As can compromise fertility
what are two management options for varicocele
Conservative
Embolisation
when is testicular embolisation offered
Pain
Infertility
what are two complications of varicocele
Testicular atrophy
Infertility
what is a hydrocele
collection fluid between visceral and parietal layers of tunica vaginalis
how does a hydrocele present
painless fluctuant swelling
how are hydrocele’s and inguinal hernias differentiated
- hydroceles = can get above
- inguinal hernia = cannot get above
what is a key feature of hydroceles on examination
transilluminable
what causes congenital hydroceles
patent processus vaginalis
in patients 20-40 years with suspected hydrocele what should be done
USS - to exclude testicular cancer
if congenital hydrocele when do they typically resolve by
6-months
when are congenital hydroceles operated on
1-year
what is balanitis
inflammation glans penis
what is balanoposthitis
inflammation glans penis and foreskin
what are features of candiasis balanitis
Itching following intercourse
White discharge
what are features of contact or allergic dermatitis balanitis
Painful
Itchy
Clear discharge
No other region affected
what are features of eczema or psoriais dermatitis balanitis
Itchy
Other regions skin affected
What usually causes bacterial balanitis
Staphylococcus
How does bacterial balanitis present
- Painful
- Itchy
- Yellow discharge
How does aerobic balanitis present
Offensive yellow discharge
What are features of lichen plants balanitis
- Wickhams striae
- Violaceous papules
What is lichen sclerosis balanitis called
Balanitis xerotica obliterans
How does balanitis xerotica obliterans present clinically
Itchy
white plaques
scarring
what can balanitis xerotica obliterans cause
urethral stricture
how does plasma cell balanitis of zoon present
well circumscribed erythematous lesions
what is circinate balanitis associated with
retir syndrome
- presents as painless erosions
what is used to manage balanitis
Saline wash out - was under foreskin
Topical hydrocortisone
how is balanitis xerotica obliterans managed
Circumscion
Topical corticosteroids
what are 4 indications for circumscision
- Recurrent balanitis
- Balanitis xerotica obliterans
- Phimosis
- Paraphimosis
what are 3 advantages of circumscion
- Reduce risk penile cancer
- Reduce risk UTI
- Reduce risk STI
what organism is the most common cause of epididymo-orchitis
chlamydia
