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MD2 Surgery and Anaesthesia > Common Presentations of Scrotal and Testicular Disease > Flashcards

Common Presentations of Scrotal and Testicular Disease Flashcards

1
Q

What is a varicocoele?

A

Varicose veins of spermatic cord

Part of testis and cord

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2
Q

On which side are varicocoeles more common?

A

Left

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3
Q

What happens to varicocoeles when you lie down?

A

Disappear

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4
Q

When should you operate on varicocoeles?

A

Longstanding dragging pain

Primary infertility

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5
Q

What does sudden onset of a hydrocoele in a young man indicate?

A

Cancer until proven otherwise

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6
Q

Can you get above a hydrocoele?

A

No

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7
Q

Can you feel the testis if a hydrocoele is present?

A

No

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8
Q

What causes primary hydrocoeles?

A

Unknown

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9
Q

What causes secondary hydrocoeles?

A

Cancer

Infection

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10
Q

How are hydrocoeles investigated?

A 
Blood markers
- Beta HCG
- Alpha foetal protein
- LDH
Ultrasound
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11
Q

What is the treatment for hydrocoeles when cancer is suspected?

A

Radical orchidectomy > see if blood markers come down

CT to look for lymph nodes - para-aortic

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12
Q

What is a spermatocoele?

A

Hydrocoele with sperm in it

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13
Q

Are the sperm dead or alive in the spermatocoele?

A

Usually dead

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14
Q

What colour is the fluid within a spermatocoele?

A

Whitish

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15
Q

What sort of hydrocoele are spermatocoele usually associated with?

A

Primary, rather than secondary

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16
Q

What is the demographic in whom testicular torsion occurs?

A

Young, up to 35

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17
Q

What is the pain associated with testicular torsion?

A

Acute
Severe
In scrotum, radiating to iliac fossa

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18
Q

What are the associated symptoms with testicular torsion?

A

Unwell
Mildly febrile
Rapid pulse
Vomiting

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19
Q

What is the position of the testis in testicular torsion?

A

Elevated

Sometimes horizontal

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20
Q

What does the skin around the testis look like in testicular torsion?

A

Swollen

Bluish

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21
Q

What is the management for testicular torsion?

A

Rush to theatre
Try to rescue ischaemic testis
Excise at scrotal raphe (in middle)
Perform orchidopexy on other side = stitch testis on raphe, to stop other side torsioning

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22
Q

How can you tell whether an ischaemic testis can be saved?

A

20 min after unravelling > make small nick > see if bleeds
If there’s blood, can be saved
If after a long while, and doesn’t bleed, have to remove it
Remove if black in colour
If questionable, can still leave in

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23
Q

Why might you leave in an ischaemic testis?

A

May be smaller, and won’t produce sperm, but will produce hormone

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24
Q

Are epididymal cysts benign or malignant?

A

Benign

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25
Q

How are epididymal cysts managed?

A

Drain > recur

Optimal treatment = epididymectomy, often bilateral

26
Q

Can you get above an epididymal cyst?

A

Yes

27
Q

Can you feel the testis if an epididymal cyst is present?

A

Yes

28
Q

What sort of fluid is an epididymal cyst filled with?

A

Serous

29
Q

What are the most common cancers of the testis?

A

Seminoma - less aggressive

Teratoma

30
Q

What are the rare cancers of the testis?

A

Leydig cell

Sertoli cell

31
Q

What are sebaceous cysts of the scrotum?

A

Sebaceous gland associated with hair follicle blocks > increases in size > becomes cyst

32
Q

What is the treatment for sebaceous cysts of the scrotum?

A

Excision

33
Q

What are the signs and symptoms of epididymo-orchitis?

A 
Severe pain
Unilateral swelling
Testis
- Big
- Hard
- Red
- Very tender
34
Q

What is the most common organism causing epididymo-orchitis?

A

E coli

35
Q

What imaging is done in suspected epididymo-orchitis?

A

Ultrasound, to make sure not missing testicular cancer

36
Q

What is the management for epididymo-orchitis?

A

Elevation
Analgesia
IV Abx

37
Q

What is Fournier’s gangrene?

A

Skin of scrotum becomes gangrenous
Goes black and dies
Testis underneath an also die

38
Q

What causes Fournier’s gangrene?

A

Usually mix of aerobes and anaerobes

39
Q

What are the risk factors for Fournier’s gangrene?

A

Diabetes

Alcohol abuse

40
Q

What can cause Fournier’s gangrene?

A

From diverticulum
Perianal abscess
Perforating cancer of anorectum

41
Q

What is the management for Fournier’s gangrene?

A

Excision - get rid of all dead skin
Abx against aerobes and anaerobes
After surgery, scrotum heals itself around testis

42
Q

What are the types of cancers of the penis?

A

SCC
BCC
Melanoma

43
Q

What are the investigations for a cancer of the penis?

A

Biopsy

Examine superficial inguinal nodes

44
Q

What is the treatment for cancer of the penis?

A

Excision and full thickness graft
If inguinal nodes involved, chemo- and radiotherapy
If up to corpus cavernosa, amputation

45
Q

What are the benign intrascrotal lumps?

A 
Hydrocoele
Epididymal cyst
Varicocoele
Benign tumour
Idiopathic scrotal oedema
46
Q

What are the malignant intrascrotal lumps?

A

Testicular cancer
Lymphoma
Other

47
Q

What are the investigations of choice for suspected testicular cancer?

A

Urgent scrotal US

Tumour markers

48
Q

Why do patients continue to die of testicular cancer if it is a highly curable disease?

A

Usually due to delay in presentation

49
Q

What is the clinical syndrome of the acute scrotum?

A

New onset scrotal pain
+/- swelling
+/- tenderness
+/- erythema

50
Q

What is the clinical approach to the acute scrotum?

A 
History
Focused exam
Investigations
- Urinalysis
- MSU
- Urethral swab/first void culture
- FBE
- US with Doppler
51
Q

What is the clinical presentation of acute torsion of the spermatic cord?

A 
Acute onset of severe pain
\+/- swelling
\+/- precipitating event
Nausea and vomiting
Early presentation
52
Q

What is the most common cause of acute scrotum in prepubertal boys?

A

Torsion of testicular appendage

53
Q

What is the presentation of torsion of testicular appendage?

A

Localised pain/tenderness in superior pole of testis
Usually less severe pain compared with testicular torsion
Blue dot sign

54
Q

What is the blue dot sign?

A

Tender nodule with blue discoloration on upper pole of testis

55
Q

What is the management for torsion of testicular appendage?

A

Conservative

- NSAIDs

56
Q

What are the risk factors for epididymitis or epididymo-orchitis?

A

IDC
Chronic retention
Structural abnormality
Instrumentation

57
Q

What are the investigations in suspected epididymitis or epididymo-orchitis?

A

Urinalysis and MSU
Urethral swab for PCR
Ultrasound

58
Q

What are the bacterial causes of epididymitis or epididymo-orchitis?

A 
Men <35
- Neisseria gonorrhoeae
- Chlamydia trachomatis
Men >35
- E coli
- Other Gram -ves
59
Q

What are the viral causes of epididymitis or epididymo-orchitis?

A

Mumps

Coxsackie

60
Q

What are the granulomatous causes of epididymitis or epididymo-orchitis?

A

TB

61
Q

What are the non-infective causes of epididymitis or epididymo-orchitis?

A

Behcet’s disease
Amiodarone
Testicular tumour

MD2 Surgery and Anaesthesia (31 decks)

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