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Renal and Urology > Lumps in the groin and scrotum > Flashcards

Lumps in the groin and scrotum Flashcards

1
Q

What is a testicular lump until proven otherwise?

A

Testicular cancer

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2
Q

What is acute, tender enlargement of the testical until proven otherwise?

A

Testicular torsion

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3
Q

How would you assess a scrotal lump?

A
  • Can you get above it?
  • Is it serparate from the testis?
  • Is it cystic or solid?
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4
Q

If a scrotal mass was separate from the testicle and cystic, what might be the cause?

A

Epididymal cyst

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5
Q

If, when examining a scrotal mass, you were unable to get above it, what might be the cause?

A
  • Inguinoscrotal hernia
  • Hydrocele extending proximally
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6
Q

What are Epididymal cysts?

A

Cysts which develop in adulthood and contain clear/milky fluid. They lie above and behind the testis

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7
Q

What is a hydrocele?

A

Fluid within the tunica vaginalis

  • Primary - caused by patent processus vaginalis
  • Secondary - tumour/trauma/infection
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8
Q

What is a varicocele?

A

Dilated veins of the pampiniform plexus - left side more commonly affected. Patients often describe feeling like a bag of worms, and can also describe a dull ache

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9
Q

What is a varicocele associated with?

A

Subfertility

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10
Q

What is a haematocele?

A

Blood collection in the tunica vaginalis

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11
Q

What is the commonest malignancy in males aged 15-44?

A

Testicular cancer

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12
Q

What are the different types of testicular cancer?

A
  • Seminoma
  • Non-seminomatous germ cell tumour
  • Mixed germ cell tumour (teratoma)
  • Lymphoma
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13
Q

What is the most common type of testicular cancer?

A

Seminoma (55%)

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14
Q

What can increase the risk of testicular cancer?

A
  • Undescended testicle - even after orchidopexy
  • Infant hernia
  • Infertility
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15
Q

How might someone present with a testicular cancer?

A
  • Painless testicular lump
  • Secondary hydrocele
  • Dyspnoea - if lung mets
  • Abdominal mass - nodal involvement
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16
Q

If someone had a lump in their testicle and dyspnoea, what might this be suggestive of?

A

Testicular cancer with lung mets

17
Q

Where do seminomas arise from?

A

Seminiferous tubules

18
Q

What is the most commonly affected age range for men to get testicular cancer?

A

15-35

19
Q

What investigations would you perform in someone with suspected testicular cancer?

A
  • Bloods - tumour markers
  • Chest X-ray
  • CT/MRI - distant mets
  • Excision biopsy
20
Q

What tumour markers would you investigate for if someone was suspected to have testicular cancer?

A
  • Alpha-fetoprotein (AFP)
  • B-human chorionic gonadotrophin
  • LDH
21
Q

What is stage 1 testicular cancer?

A

No evidence of metastasis

22
Q

What is stage 2 testicular cancer?

A

Infradiaphragmatic node involvement

23
Q

What is stage 3 testicular cancer?

A

Supradiaphragmatic node involvement

24
Q

What is stage 4 testicular cancer?

A

Lung involvement

25
Q

What characteristics on tumour marker investigation indicate that a testicular tumour could be a seminoma?

A
  • Raised LDH
  • Possible mildly raised HCG
  • Never a raised AFP
26
Q

How would you manage someone with testicular cancer?

A
  • Stage 1 seminoma - Radical orchidectomy + radiotherapy
  • NSGCT - 3 cycles bleomycin + etoposide + cisplatin
27
Q

If a lump on the testicle was found to be solid and separate from the testicle, what might be the cause?

A
  • Epididymitis
  • Varicocele
28
Q

If a lump on the testicle was found to be attached/within the testicle and solid, what could be the cause?

A
  • Tumour
  • Haematocele
  • Granuloma
  • Orchitis
29
Q

What is testicular torsion?

A

Occurs when the spermatic cord (from which the testicle is suspended) twists, cutting off the testicle’s blood supply, a condition called ischemia

30
Q

What are symptoms of testicular torsion?

A
  • Sudden onset pain in one testis - can spread to abdomen
  • Nausea, vomiting
31
Q

What are signs of testicular torsion?

A
  • Tender, inflammed, swollen testis
  • Scrotal erythema
  • Testicle may lie high and transversely
  • Absent cremaster reflex
  • Thickened cord
32
Q

What would your differential diagnosis in someone with a rad, swollen, painful testicle?

A
  • Torsion
  • Epididymorchitis
  • Tumour
  • Trauma
  • Acute hydrocele
33
Q

What investigations would you do if you suspected testicular torsion?

A

Doppler US - only if diagnosis equivocal

34
Q

How would you manage a testicular torsion?

A
  • Bilateral fixation (orchidopexy) +/- orchidectomy
35
Q

If surgery is performed within 6 hours of presentation, what is the salvage rate?

A

90-100%

36
Q

If surgery for testicular torsion is performed >24 hrs after initial presentation, what is the salvage rate?

A

0-10%

Renal and Urology (51 decks)

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