Non malignant scrotal disease

Question 1

Another name for epididymal cyst

Answer 1

spermatocele

Question 2

What is an epididymal cyst

Answer 2

A retention cyst of a tubule of the rete testis or the head of the epididymis distended with barely watery fluid that contains spermatozoa

Question 3

clinical features epididymal cyst

Answer 3

not painful

large ones can be uncomfortable

Question 4

aetiology epididymal cyst

Answer 4

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

Question 5

diagnosis epididymal cyst

Answer 5

physical exam

USS

Question 6

rx epididymal cyst

Answer 6

small cysts left alone
large asymptomatic cysts left alone
spermatocelectomy may not improve symps

Question 7

hydrocele

Answer 7

a pathological accumulation of serous fluid in a body cavity - in this case around a testicle
caused by fluid secreted by tunica vaginalis

Question 8

aetiology hydrocele

Answer 8

• 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

Question 9

primary hydrocele

Answer 9

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

Question 10

secondary hydrocele

Answer 10

cancer
trauma (eg hernia)
orchitis (inflammation of testis)
underlying testis is palpable

Question 11

diagnosis hydrocele over tumour

Answer 11

attempting to shine a strong light through the enlarged scrotum
a hydrocele will usually pass light while a tumour will not

Question 12

clinical diagnosis hydrocele

Answer 12

primary hydrocele has:
transillumination positive
fluctuation positive
impulse on coughing
testis cannot be palpated separately

Question 13

rx hydrocele

Answer 13

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

Question 14

varicocele

Answer 14

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

Question 15

serious result of varicocele if not treated

Answer 15

one of the main causes for infertility

Question 16

signs and symptoms varicocele

Answer 16

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

Question 17

what side do majority of varicoceles occur on

Answer 17

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

Question 18

cause secondary varicocele

Answer 18

compression of testicular drainage due to pelvic or abdo malignancy

Question 19

diagnosis varicocele

Answer 19

non tender twisted mass along spermatic cord
testicle on side of varicocele may be smaller
reliably diagnosed with USS

Question 20

rx varicocele

Answer 20

surgery

embolisation / blockage of pampiniform plexus

Question 21

testicular torsion

Answer 21

occurs when the spermatic cord twists cutting off the testicles blood supply causing ischaemia

Question 22

symptom testicular torsion

Answer 22

rapid onset of testicular pain

Question 23

cause testicular torsion

Answer 23

congenital malformation - bell clapper deformity where testis is inadequately affixed to the scrotum allowing it to move freely on its axis

Question 24

diagnosis testicular torsion

Answer 24

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

Question 25

rx testicular torsion

Answer 25

surface of the testicle needs to be rotated toward the midline of the body
non surgical correction can sometimes be accomplished by manually rotating the testicle in the opposite direction
If not - it is a surgical emergency