Non malignant scrotal disease Flashcards
Another name for epididymal cyst
spermatocele
What is an epididymal cyst
A retention cyst of a tubule of the rete testis or the head of the epididymis distended with barely watery fluid that contains spermatozoa
clinical features epididymal cyst
not painful
large ones can be uncomfortable
aetiology epididymal cyst
can originate as diverticulum from the tubules found in the head of the epididymis
sperm formation gradually causes the diverticulum to increase in size, causing a spermatocele
can also result from epididymitis or physical trauma
diagnosis epididymal cyst
physical exam
USS
rx epididymal cyst
small cysts left alone
large asymptomatic cysts left alone
spermatocelectomy may not improve symps
hydrocele
a pathological accumulation of serous fluid in a body cavity - in this case around a testicle
caused by fluid secreted by tunica vaginalis
aetiology hydrocele
- excessive production of fluid within the sacc
- defective absorption of fluid
- interference with lymphatic drainage
- connection with a hernia of the peritoneal cavity in the congenital variety, which presents as hydrocele of the cord
primary hydrocele
swelling is soft and non tender
large in size
testis cant be felt
can get huge but no pain - in LT can cause atrophy of testis
secondary hydrocele
cancer
trauma (eg hernia)
orchitis (inflammation of testis)
underlying testis is palpable
diagnosis hydrocele over tumour
attempting to shine a strong light through the enlarged scrotum
a hydrocele will usually pass light while a tumour will not
clinical diagnosis hydrocele
primary hydrocele has: transillumination positive fluctuation positive impulse on coughing testis cannot be palpated separately
rx hydrocele
most resolve without rx
surgical removal for persisting
if tumour suspected, hydrocele must NOT be aspirated as malignant cells can be disseminated via the scrotal skin to its lymphatic field - this is excluded by USS and it can then be aspirated
varicocele
abnormal enlargement of the pampiniform venous plexus in the scrotum
this plexus drains the testicle
defective valves or compression of the vein can cause dilatation of the testicular veins leading to the formation of a varicocele
serious result of varicocele if not treated
one of the main causes for infertility
signs and symptoms varicocele
visible or palpable enlarged vein dragging like or aching pain in scrotum feeling of heaviness in testicle atrophy of testicles alteration of testosterone levels BPH and related urinary problems
what side do majority of varicoceles occur on
left side because left testicular vein travels superiorly and connects to the left renal vein (at 90 deg angle), while the right testicular vein drains directly into the IVC
cause secondary varicocele
compression of testicular drainage due to pelvic or abdo malignancy
diagnosis varicocele
non tender twisted mass along spermatic cord
testicle on side of varicocele may be smaller
reliably diagnosed with USS
rx varicocele
surgery
embolisation / blockage of pampiniform plexus
testicular torsion
occurs when the spermatic cord twists cutting off the testicles blood supply causing ischaemia
symptom testicular torsion
rapid onset of testicular pain
cause testicular torsion
congenital malformation - bell clapper deformity where testis is inadequately affixed to the scrotum allowing it to move freely on its axis
diagnosis testicular torsion
made on presenting signs and symptoms
urgent US if diagnosis unclear
irreversible ischaemia occurs after 6h of onset so emergency diagnosis and rx requires to minimise testicle loss
