134. Non-neoplastic diseases of the scrotum, testis and epididymis.

Question 1

scrotal enlargment

Answer 1

varicocele:
dilation of spermatic vein due to impaired drainage, mostly on left side
left spermatic vein is connected to left renal vein and may obstruct its flow
associated with renal cell carcinoma which can invade and block the left renal vein

hydrocele:
accumulation of serous fluid within tunica vaginalis
can be idiopathic or due to neighboring infections or tumors (also can be due to incomplete closure of processus vaginalis-infants or blockage of lymphatic drainage-adults)
its a clear fluid which can be transluminated

haematocele: accumulation of blood in tunica vaginalis mostly due to trauma
chylocele: accumulation of lymphatic fluid might be due to extreme lymphatic obstruction like in the parasitic disease filarasis.

Question 2

Cryptorchidism and testicular atrophy

Answer 2

definition: failure of testicles to descend into the scrotum causing primary atrophy.

normally:
transabdominal: testes descend from abdomen into
pelvis by the third month of gestation
inguinoscrotal: from pelvis to scrotum in the last 2
months of intrauterine life.

diagnosis: only at 1 year of age

usually unilateral

complications:
sterility: testes become atrophic after a couple of
years and leads to infertility. even in unilateral cases
neoplasia: 3-5 fold risk for testicular cancer (germ cell
neoplasia in situ); even in unilateral cryptorchidism

secondary atrophy
other situations that lead to testicular atrophy which
are not testis related. Like ischemia, inflammation,
cirrhosis, irradiation

Question 3

Inflammatory lesions

Answer 3

mostly in epididymis and not in testis proper

orchitis: inflammation of the testes

causes: STDs, mumps, tuberculosis
- non-specific orchitis: starts as UTI, mostly STDS (e.
coli, chlamydia, n. gonorrhoeae) and spread to testis
via vas deferens or lymphatics of spermatic cord
- mumps infection: post-puberty, severe mumps
orchitis may lead to extensive necrosis, loss of
seminiferous epithelium, tubular atrophy, fibrosis, and
sterility.
- tuberculosis/autoimmune: testicular tuberculosis
begins at epididymis with secondary involvement of
testis, shows granulomatous inflammation and
caseous necrosis. (in autoimmune there are non-
necrotizing granulomas)

Question 4

Torsion

Answer 4

definition: twisting of the spermatic cord
pathogenesis: obstruction of testicular venous drainage while the arteries remain patent, this leads to vascular engorgement and hemorrhagic infarction.

2 types:
Neonatal torsion: in utero or shortly after birth
Adult torsion:
- in adolescence and manifests with sudden onset of
testicular pain/absent cremasteric reflex
- congenital anomaly: testis is abnormally anchored in
the scrotal sac giving rise to increased mobility (bell
clapper abnormality)

prognosis: emergency, if it’s repaired in 6 hrs then its all good.