Non-cancer Scrotal diseases Flashcards
Any scrotal mass should be treated as ____ until proven otherwise
cancer
Where is an epidydimal cyst located?
Extra testicular cyst, above and behind testis
True or false: an epidydimal cyst will transilluminate?
True
How do you diagnose an epidydimal cyst?
USS of scrotum
What is an epidydimal cyst containing sperm called?
Spermatocele (managed same as epidydimal cyst)
A hydrocele is a fluid collection in the…
tunica vaginalis
(originally part of peritoneal membrane, during development of fetus separates and remains in scrotum, partially covering each testicle.)
True or false: a hydrocele will transilluminate
True
What is a communicating hydrocele?
Tunica vaginalis is connected to the peritoneal cavity via the processus vaginalis allowing fluid to travel from the peritoneal cavity into the hydrocele.
Hydrocele may fluctuate in size.
How do you diagnose a hydrocele?
USS of scrotum
What can hydroceles be secondary to?
(can be idiopathic)
Testicular cancer
Testicular torsion
Epididymo-orchitis
Trauma
How are hydroceles managed?
In new-borns will often recede as liquid is reabsorbed over time.
Can have surgery, aspiration or sclerotherapy in large of symptomatic cases.
Where does the pampiniform plexus drain into?
Testicular vein
What is a varicocele?
Distended pampiniform plexus veins due to increased resistance in testicular vein and incompetent valves allowing blood to flow back into the pampiniform plexus.
(mass of varicose veins in spermatic cord)
What does the right testicular vein drain into?
The inferior vena cava
What does the left testicular vein drain into?
The left renal vein
What side is a varicocele mostly found?
Left
What can a left-sided varicocele indicate?
Obstruction of left testicular vein caused be a renal cell carcinoma
What is a varicocele often described as?
Bag of worms
Is a varicocele painful?
Rarely when larger and more severe but typically they’re painless.
What is a complication of varicocele?
Infertility
Probably to do with disrupting temperature of affected testicle.
How do you diagnose a varicocele?
Physical examination
Doppler USS can provide details image of veins in scrotum.
Should a varicocele disappear when lying down?
Yes, if not raises alarms of possible retroperitoneal tumours obstructing the drainage of the renal vein.
What is testicular distorsion?
Spermatic cord twists on itself, occluding the testicular artery causing ischaemia.
If testicular distortion is treated, what happens
Gangrene of testis
What is a risk factor for testicular torsion?
Bell clapper deformity (“horizontal lie” of testes)
How would a patient with testicular torsion present?
Severe uni-testicular pain (hurts to walk)
Abdominal pain
N&V
No pain relief with elevating testis
Cremasteric reflex lost.
What is the cremasteric reflex?
Stroke inner thigh, ipsilateral testicle should elevate/retract upwards
How do you diagnose testicular torsion?
1st line = Surgical exploration - emergency
USS to check testicular blood flow
How do you treat testicular torsion?
urgent surgery within 6 hours (90-100% success rate)
What is Prehn’s sign and when is it used?
Lifting half of the scrotum to assess consequent change in pain used to determine cause.
Positive = relief of pain
Negative = exacerbation of pain
What does a positive Prehn’s sign indicate
Relief of pain suggests acute or chronic epididymitis (bacterial infection often from STIs)
What does a negative Prehn’s sign indicate?
Exacerbation of pain suggests testicular torsion as spermatic cord compressed
