Lumps In The Groin And Scrotum Flashcards
What is the it if you cant get above it
Inguinal hernia
Proximally extending hydrocele
Varicocele
If it is separate from the tests and cystic what is it
Epididymal cyst
If it is separate and sold what is it
Epididymitis/varicocele
Testicular and Cystic what is it
Hydrocele
If it is testicular and solid what is it
Tumour Hametocele Granuloma Orchitis Gumma - tertiary syphilis
What is a testicular lump until proven otherwise
Tumour
What is acute tender enlargement of the testis until proven otherwise
Torsion
What is a hydrocele
Fluid within he tunica vaginalis
Types of hydrocele
Primary: Associated with patent processes vaginalis
Which typically resolves around 1 yo
Secondary: to a testes tumour.infection/trauma primary are more common larger and usually in younger men
Can resolve spontaneously
Tx of hydroceles
Aspiration- which may need repeating
Surgery - plicating the tunica vaginalis - Lords repair
Or jaboulays repair - inverting the sac
Causes of epididymoorchitis
Chlamydia <35yrs
E. coli, mumps,
N, gonorrhoea
TB
Features of epididymorchits
Sudden onset tender swelling, dysuria, sweats/fever, urethral discharge
Ix epididymitis-orchitis
First catch urine sample
STI screen
Tx of epididymitis-orchitis
<35yrs doxycycline - chlamydia contact trace
Gonorrhoea is suspected add centric one
If >35 and non STI - UTI associations more common
So try ciprofloxacin 2-4 weeks ab
Also analgesia
Scrotal support
Drain any abscess
What is a varicocele
Dilated veins of the pampiniform plexus Left side more commonly affected Often visible Feel like a bag of worms May have a dull ache Associated with sub fertility Left side more commonly affected as connects to renal vein bot straight to IVC
What is a haematocele
Blood in the tunica vaginalis
Follows trauma
May need drainage/excision
Types of testicular tumours
Seminoma
Non seminomatous germ cell tumour
Mixed
Lymphoma
Age range most commonly affected with testicular tumours
15-44 yrs
Signs of test cancer
Painless testis lump Found after trauma+/- infection +/- haematospermia Ecndary hydrocele Aim Dyspnoea - lung mets Ado mass - enlarged nodes Or effects of secreted hormones
Risk factors for test ca
Undescended testes
Infant hernia
Infertility
What percentage of test ca present with mets
50% NTSGCC
25% seminoma
Staging of test ca
1 - no mets
2- infradiagphragmairc node involvement
3- supradiaphragmatic node involvement
4 - lung involvement- haematogenous spread
Tests tes ca
CXR CT Excision biopsy Alpha FP HCG Useful tumour markers
Tx test ca
Radical orchidectomy
Seminoma radiosensitive orchidectomy + radio 95% cure
NSGCT even with mets 3 cycles chemo - 5 years survival >90%
