Groin/scrotal lumps

Question 1

DD of swellings?

Answer 1

Cant get above? Hernia
Separate, cyst: epidydimal cyst
Separate, solid: varicocele, sperm granuloma, epididimitis
Testicular, cystic: hydrocele
Testicular, solid: tumour, orchitis, haematocele

Question 2

What are epidydimal cysts?

Answer 2

Develop in adulthood, contain clear or milky (spermatocele) fluid
Lie above and behind testis
remove if symptomatic

Question 3

What is a varicocele and what does it feel like?

Answer 3

Dilated veins of pampiniform plexus

bag of worms in the scrotum, may be visible dilated veins, decreases in size if lying down and patient may complain of dull ache

Question 4

Pathology of Varicocele?

Answer 4

Left side commoner in primart as drains into left renal vein

secondary= tumour tracked down left renal vein

Question 5

Management of varicocele?

Answer 5

Conservative: scrotal support
Surgical: clip the vein

Question 6

Complications of varicocele?

Answer 6

can cause subfertility, though repair doesnt seem to improve rates of pregnancy

Question 7

What is a sperm granuloma?

Answer 7

Painful lump of extravasated sperm after vasectomy

Question 8

What is a hydrocele?

Answer 8

Collection of fluid in the tunica vaginalis

Question 9

Primary v secondary hydrocele?

Answer 9

Primary is associated with a patent process vaginalis, commoner larger, young

Secondary is due to trauma, tumour, infection
smaller and less tense

Question 10

Ix in hydrocele?

Answer 10

US to exclude a tumour

Question 11

Mx of Hydrocele?

Answer 11

May resolve spontaneously
Surgery: lords- plication of sac
Jabouleay- eversion of sac
Aspiration: usually recur so not first line, send fluid for cytology, mc and s

Question 12

What is a haematocele?

Answer 12

Blood in tunica vaginalis, hx of trauma and may need drainage/incision

Question 13

Aeitiology of epididymo-orchitis?

Answer 13

STI: chlamydia, gonnorhea
ascending UTi: Ecoli
Mumphs

Question 14

Features of epididymo-orchitis?

Answer 14

Sudden onset tender swelling, dysuria, fever
Tender warm and swollen testis, elevating testicle may reduce pain
Secondary hydrocele
discharge

Question 15

Ix in epididymo-orchitis?

Answer 15

Blood: fbc/crp
urine dip
urethral swab and UTI screen
US may be needed to exclude abscess

Question 16

Complications of epididymo-orchitis?

Answer 16

May decrease fertility

Question 17

Mx of epididymo-orchitis?

Answer 17

Bed rest, analgesia, scrotal support
abx according to infection
drain any abscess

Question 18

Aeitiology of testicular torsion?

Answer 18

usually secondary to minor trauma

occus as testicle doesnt have good area to attach to scrotal wall

Question 19

Presentation of testicular torsion?

Answer 19

10-25yrs
sudden onset severe pain
lower abdominal pain
n/v
hx of previous torsion

Question 20

Examination of torsion?

Answer 20

Inflammation of one testis, hot, swollen and ext. tender
Rides high and lies transversely
loss of cremasteric reflex

Question 21

DD of testicular torsion?

Answer 21

Epidydimoorchitis: slower and older

Torted hydratid of morgagni
remnant of mullerian duct. younger, less painful and tiny blue dot

tumour
trauma
appendicitis

Question 22

Ix in testicular torsion?

Answer 22

US may show absence of flow but DO NOT DELAY surgical exploration

Question 23

Mx of testicular torsion?

Answer 23

SURGICAL EMERGENCY
4-6hr window to salvage testis
inform senior, NBM
Iv access: analgesia and take bloods
Surgery: consent for possible orchidectomy, bilateral orchidoplexy- surture testes to scrotum
If no torsion and EDO a DD then take fluid sample for bacteriology