benign scrotal pathology Flashcards
what is the dense fascial covering of the testes
tunica albuginea testis
what is the mediastinum testis
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
what is the serous tunica vaginalis
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
what is the blood supply to the testes
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
what is the bell clapper deformity of the testies
a condition where the testis lacks a normal attachment to tunica vaginalis and hangs freely -> susceptible to testicular torsion
where does the pempiniform plexus drain into
on the right side - enters the vena cava just below the renal vein
on the left side - empties into the left renal vein
what is the epididymis
A narrow, tightly-coiled tube that is attached to each of the testicles
epididymis globus major vs globus minor
globus major - upper portion, connected to the testis by numeroud efferent ducts
globus minor - lower portion that is continuous w vas deferens
what is the lymphatic drainage of the testes
external iliac and internal iliac (lumbar lymph nodes) -> connected to the mediastinal nodes
what is the appendix of the epididymis
a small appendage on the top of the epididymis - a cystic body that can be peduncilated or sessile
at what week of embryological development do the gonads assume characteristics of a testes
week 7
what is the mesorchium
the fold of peritoneum that attaches the testis to the dorsal wall in the fetus (gonadal mesentery)
what is the descent of testis
the movement of the testes in the foetus from the abdominal cavity into the scrotum
where are the testes located in the 3rd month of foetal development
retroperitoneally in the false pelvis
what is the gubernaculum
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
what can failure of testis descent lead to
- communicating hydrocele
- infantile hernia
- ectopic testis
- undescended testes
what is gonadal agenesis
the lack of development of the gonads
what is incomplete development of the gonads with arrest at a certain phase
hypogenesis
what are supernumerary gonads
the presence of more than two testes
what is cryptorchidism
retention of the testis in the abdomen or arrest of its descent at any point along its natural pathway
how can an ectopic testis arise during testicular descent
if the testis does not follow the main gubernacular structure and instead follows one of the subsidiary strands
what does failure of union between the rete testis and the mesonephros result in
a testis that is separate from the male genital ducts (epididymis) -> azoospermia
what is the most common genital problem encountered in pediatrics
cryptorchidism
cryptorchidism mgx
orchiopexy (relocates testes into the scrotum)
what are pts with cryptorchidism at risk of in the future (2)
- infertility
- testis cancer
general rule for telling is a mass in the scrotum is malignant
if arising from the testes - malignant
if arising from the spermatic chord - benign
what is a communicating hydrocoele
a common abnormality seen in children caused by the failure of closure of the processus vaginalis after descent
communicating hydrocoele mgx (2)
- most resolve in the first year of life
- if non resolving the surgical treatment comprising ligation of the patent processus vaginalis through a small groin incision
what is a haematocoele
collections of blood within the scrotal sac, but outside of the testis -> does not transilliminate while a hydrocoele does
why is a hydrocoele not aspirated
the turnica soon refils with fluid post aspiration
where do cysts of the epididymis arise from
diverticula of the vasa efferentia
cyst of the epididymis vs hydrocoele
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
what is the pawnbroker’s sign
“fable of three testes” - when a solitary epidydimal cyst is present and it resembles a third testis
what is a spermatocoele
when fluid within an epididymal cyst is opalescent and contains sperm
epididymal cyst mgx
leave it alone! (unless the size warrants excision)
what can occur as complications if an epididymal cyst is removed (2)
- reccurence -> often several other little cysts are present and will eventually increase in size and produce a recurrence
- if all cysts are removed the sperm pathway will be damaged -> sterililty can occur in bilateral operation
when should a varicocoele be urgently referred (3)
- It appears suddenly and is painful
- Does not drain when lying down
- Solitary right-sided varicocele
