benign scrotal pathology

Question 1

what is the dense fascial covering of the testes

Answer 1

tunica albuginea testis

Question 2

what is the mediastinum testis

Answer 2

a thick yet incomplete septum at the posterior part of the testis formed by the tunica albuginea of testis projecting into the testis at its posterior aspect

Question 3

what is the serous tunica vaginalis

Answer 3

a pouch of serous membrane within the scrotum that lines the testis and epididymis, and the inner surface of the scrotum -> the layer is continuous with the parietal layer that separates the testis from the scrotal wall

Question 4

what is the blood supply to the testes

Answer 4

closely associated w the kidneys
arterial - internal spermatics which arises from the aorta just below the renal arteries, it runs along the spermatic chord
venous - pampiniform plexus of the spermatic chord -> the internal inguinal ring becomes the spermatic vein

Question 5

what is the bell clapper deformity of the testies

Answer 5

a condition where the testis lacks a normal attachment to tunica vaginalis and hangs freely -> susceptible to testicular torsion

Question 6

where does the pempiniform plexus drain into

Answer 6

on the right side - enters the vena cava just below the renal vein
on the left side - empties into the left renal vein

Question 7

what is the epididymis

Answer 7

A narrow, tightly-coiled tube that is attached to each of the testicles

Question 8

epididymis globus major vs globus minor

Answer 8

globus major - upper portion, connected to the testis by numeroud efferent ducts
globus minor - lower portion that is continuous w vas deferens

Question 9

what is the lymphatic drainage of the testes

Answer 9

external iliac and internal iliac (lumbar lymph nodes) -> connected to the mediastinal nodes

Question 10

what is the appendix of the epididymis

Answer 10

a small appendage on the top of the epididymis - a cystic body that can be peduncilated or sessile

Question 11

at what week of embryological development do the gonads assume characteristics of a testes

Answer 11

week 7

Question 12

what is the mesorchium

Answer 12

the fold of peritoneum that attaches the testis to the dorsal wall in the fetus (gonadal mesentery)

Question 13

what is the descent of testis

Answer 13

the movement of the testes in the foetus from the abdominal cavity into the scrotum

Question 14

where are the testes located in the 3rd month of foetal development

Answer 14

retroperitoneally in the false pelvis

Question 15

what is the gubernaculum

Answer 15

a fibromuscular band that extends from the lower pole of the testis through the developing muscular layers of the anterior abdominal wall to terminate in the subcutaneous tissue of the scrotal swelling -> important in testicular descent

Question 16

what can failure of testis descent lead to

Answer 16

1. communicating hydrocele
2. infantile hernia
3. ectopic testis
4. undescended testes

Question 17

what is gonadal agenesis

Answer 17

the lack of development of the gonads

Question 18

what is incomplete development of the gonads with arrest at a certain phase

Answer 18

hypogenesis

Question 19

what are supernumerary gonads

Answer 19

the presence of more than two testes

Question 20

what is cryptorchidism

Answer 20

retention of the testis in the abdomen or arrest of its descent at any point along its natural pathway

Question 21

how can an ectopic testis arise during testicular descent

Answer 21

if the testis does not follow the main gubernacular structure and instead follows one of the subsidiary strands

Question 22

what does failure of union between the rete testis and the mesonephros result in

Answer 22

a testis that is separate from the male genital ducts (epididymis) -> azoospermia

Question 23

what is the most common genital problem encountered in pediatrics

Answer 23

cryptorchidism

Question 24

cryptorchidism mgx

Answer 24

orchiopexy (relocates testes into the scrotum)

Question 25

what are pts with cryptorchidism at risk of in the future (2)

Answer 25

1. infertility
2. testis cancer

Question 26

general rule for telling is a mass in the scrotum is malignant

Answer 26

if arising from the testes - malignant
if arising from the spermatic chord - benign

Question 27

what is a communicating hydrocoele

Answer 27

a common abnormality seen in children caused by the failure of closure of the processus vaginalis after descent

Question 28

communicating hydrocoele mgx (2)

Answer 28

1. most resolve in the first year of life
2. if non resolving the surgical treatment comprising ligation of the patent processus vaginalis through a small groin incision

Question 29

what is a haematocoele

Answer 29

collections of blood within the scrotal sac, but outside of the testis -> does not transilliminate while a hydrocoele does

Question 30

why is a hydrocoele not aspirated

Answer 30

the turnica soon refils with fluid post aspiration

Question 31

where do cysts of the epididymis arise from

Answer 31

diverticula of the vasa efferentia

Question 32

cyst of the epididymis vs hydrocoele

Answer 32

cysts
1. always almost multiple and so are nodular on palpation;
2. located above and behind the testis which is palpable separate form the cysts
3. always transilluminate brightly

Question 33

what is the pawnbroker’s sign

Answer 33

“fable of three testes” - when a solitary epidydimal cyst is present and it resembles a third testis

Question 34

what is a spermatocoele

Answer 34

when fluid within an epididymal cyst is opalescent and contains sperm

Question 35

epididymal cyst mgx

Answer 35

leave it alone! (unless the size warrants excision)

Question 36

what can occur as complications if an epididymal cyst is removed (2)

Answer 36

1. reccurence -> often several other little cysts are present and will eventually increase in size and produce a recurrence
2. if all cysts are removed the sperm pathway will be damaged -> sterililty can occur in bilateral operation

Question 37

when should a varicocoele be urgently referred (3)

Answer 37

1. It appears suddenly and is painful
2. Does not drain when lying down
3. Solitary right-sided varicocele