239: Benign Scotal Conditions

Question 1

The internal spermatic fascia is an extension of which layer of the abdominal wall?

Answer 1

Transversalis fascia

Question 2

What are the 3 arterial blood supplies to the testes?

Answer 2

1. Testicular artery (from aorta)
2. Artery of the Vas Deferens (from internal illiac)
3. Cremasteric artery (from inferior epigastric)

Question 3

What are the boundaries of Hesselbach’s (aka the inguinal) triangle?

Answer 3

• Inguinal ligament (inferior)
• Inferior epigastric (lateral)
• Rectus abdominus (medial)

Question 4

The dartos and smooth muscle is an extension of which layer of the abdominal wall?

Answer 4

Subcutaneous tissue

Question 5

From which artery is the cremasteric artery derived?

Answer 5

Inferior epigastric artery

Question 6

What kind of varicocele warrants imaging of the retroperitneum?

Answer 6

Solitary right varicocele

• 90% of varioceles occur on the left side*
• Right varicocele: suspicion for tumor impeding venous drainage*
• Left varicocele: can be explained by normal anatomy (SMA crushes renal vein against abdominal aorta, backs up into renal ven -> gonadal vein)*

Question 7

What causes an indirect inguinal hernia?

Where is it located, relative to the inferiror epigastric vessels?

Answer 7

Patent processus vaginalis. Bowel slipping through inguinal canal to the scrotum

Lateral to the inferior epigastric vessels in the inguinal triangle

Question 8

Dysfunction in which structure results in a varicocele?

Answer 8

Dilation of pampiniform plexus due to incompetent or absent valves

Blood backs up in the scrotum

“bag of worms”

Left variocele much more common because left veins connect to left renal vein. Right connects to IVC.

Question 9

What is a bell-clapper deformity?

Answer 9

Tunica vaginalis is NOT fused to epididymis like it should.

Allows testicle to spin. Predisposes to torsion.

Question 10

The cremasteric fascia is an extension of which layer of the abdominal wall?

Answer 10

Internal oblique

Question 11

The tunica vaginalis is an extension of which layer of the abdominal wall?

Answer 11

Peritoneum

Question 12

The external spermatic fascia is an extension of which layer of the abdominal wall?

Answer 12

External oblique

Question 13

What are the features of each grade of varicocele?

Answer 13

• Grade 1: only perceptible with valsalva
• Grade 2: perceptible w/o valsalva
• Grade 3: visible through scrotal skin (“see across the room”)

Question 14

How does the drainage of the left and right gonad differ?

Answer 14

Right gonad -> IVC

Left gonad -> left renal vein -> IVC

=> left side more likely to have a varocele

Question 15

Which gives rise to the artery of the vas deferens?

Answer 15

Internal illiac artery

Note: Artery to the vas is the most important collateral vessel to the gonad

Question 16

What causes a diret inguinal hernia?

Where is it located, relative to the inferiror epigastric vessels?

Answer 16

Weakness in the abdominal wall (transversalis fascia)

Medial to the inferior epigastric vessels - sits in the middle of Hasselbach’s triangle

Question 17

What are the symptoms of testicular torsion?

Answer 17

Sudden onset

Sharp, intense pain

Nauseau and vomiting

UROLOGIC EMERGENCY

Question 18

What are the findings of testicular torsion on physical exam?

Answer 18

• Scrotal asymmetry (one higher than another)
• Edema, erythema
• Tenderness
• Horizontal lie
• High scrotal location
• Lack of cremasteric reflex

Question 19

What is the presentation of epididymitis?

Answer 19

• Subacute onset of pain (days)
• Normal vertical lie
• Urinary complaints (discharge)
• Systemic signs of infection (feber, elevated WBCss)
• Cremasteric reflex preserved

Question 20

Identify the type of hernia

Answer 20

A- direct, through abdominal wall

B- indirect, through inguinal canal