Disorders of the Testes, Scrotum and Penis Flashcards
1
Q
What are differentials for testicular lumps?
A
2
Q
Testicular torsion is the twist of the spermatic cord resulting in testicular ischaemia and necrosis.
Who is testicular torsion common in?
A
- Any age but most common 11-30yrs
- Teenagers will be shy so need to specifically ask for pain in testis or lower abdo
- If surgery performed in < 6 hr → salvage rate is 90-100%, if > 24hr → 0-10%
3
Q
What are clinical features of testicular torsion?
A
- Sudden onset of pain in one testis
- Walking uncomfortable
- Pain in lower abdomen
- N+V
- Not wanting to be examined due to severity of pain
- Inflammation of one testis → very tender, hot and swollen
4
Q
What is the management of testicular torsion?
A
- Doppler USS may demonstrate lack of blood flow in testis - only perform if diagnosis equivocal
- URGENT SURGICAL EXPLORATION
- If a torted testis is identified then both testis should be fixed as the condition of bell clapper testis is often bilateral
- If surgery not possible, then manual detorsion 180o like opening a book
5
Q
What are hydroceles?
A
- An accumulation of fluid within the tunica vaginalis
- Most hydroceles are primary (idiopathic) caused by localised increased production of serous fluid, although may be secondary to a tumour/infection
- They are not separate from testis; they are transilluminable and normally it is possible to feel above the lump
- Can resolve spontaneously
6
Q
What is the treatment of hydroceles?
A
- Aspiration (may need repeating) → straw colour fluid
- Surgery → plicating the tuna vaginalis (Lord’s repair) or inverting the sax (Jaboulay’s repair)
- Most common complication is haematoma formation, which occasionally may become more painful than the original hydrocele
7
Q
What is a varicocele?
A
- Dilatation of veins of pampiniform plexus within the spermatic cord
- Pt may become subfertile as result
- Almost all are left-sided (95%) as inc venous pressure in left testicular vein as it drains at right angle into left renal vein, causing turbulent flow: the right testicular vein drains at lesser angle, directly into the IVC and so does not suffer this problem
- May feel like a bag of worms + disappears on lying down
- May rarely give rise to haematospermia
8
Q
What is the management of varciocele?
A
- Usually conservative, reassurance may suffice
- Surgery used for heavy or aching varcioceles or for men who are subfertile as result of varciocele
- Affected testicular veins are divided and embolised
9
Q
What are epididymal cysts?
A
- Occur more often in men > 40 yrs
- One or multiple swellings are felt in scrotum behind testis; these lumps are transilluminable
- A cyst that causes discomfort/v large can be removed by surgery (enucleation)
- However, poses risk to fertility in young men
10
Q
How do spermatoceles differ to epididymal cysts?
A
- Similar
- But contain sperm
- So not transilluminable
11
Q
What is epididymitis and its most likely cause?
A
- Infection of epididymus → scrotal discomfort + pain during micturition
- More common >20 yrs, in whom the most common cause is chlamydial infection
- In older men, more likely to be caused by E.coli
12
Q
What is orchitis and its most common cause?
A
- Infection of testis
- Most commonly caused by viral infection, particularly paramyxovirus (mumps)
- If the swelling does not settle, the testis should be examined further for possibility of tumour
If epidymitis spreads to testis → ‘epididymo-orchitis’
13
Q
A urethral stricure is a narrowing caused by scarring of lining of urethra and surrounding corpus spongiosum.
What are causes?
A
- Idiopathic
- Inflammatory → STI (eg. gonorrhoea), chronic inflammation (eg. lichen sclerosus)
- Traumatic → a fall astride the cross-bar of a bicycle, other curshing pelvic trauma
- Iatrogenic → caused by med intervention (eg repeated urological procedures, urethral catheterisation or radiotherapy)
- Congenital → hypospadias
14
Q
What are symptoms of urethral stricture?
A
- Voiding symptoms → poor urinary flow, straining, dribbiling
- UTI → inc urinary frequency, dysuria
- Retention → unable to pass urine causing lower abdo pain
15
Q
How is urethral stricture diagnosed?
A
- Urethrogram
- Catheter passed inside tip of penis
- Dye injected to show up on x-ray
