Non-malignant scrotal disease Flashcards
Examples
Epididymal cyst
Hydrocele
Varicocele
What is an epididymal cyst
Extratesticular, spherical cysts in the head of the epididymis
Clinical presentation of epididymal cyst
Lump
Often multiple and bilateral
Often asymptomatic
Aetiology of epididymal cyst
Possibly obstruction of the epididymis
Epidemiology of epididymal cyst: onset age
Around 40
Diagnosis of epididymal cyst
Ultrasound
Transilluminate
Treatment of epididymal cyst
Not usually necessary
Surgical excision
What is a hydrocele
Abnormal collection of fluid within the remnants of the processus vaginalis
Types of hydrocele
Simple
Communicating
Non-communicating
Pathophysiology of simple hydrocele
Accumulation of fluid within tunica vaginalis.
Usually disappears in the first 2 years of life.
Aetiology of simple hydrocele
Congenital
Trauma, testicular torsion
Also possibly due to generalised oedema from other cause
Clinical presentation of simple hydrocele
Scrotal enlargement with a non-tender, smooth cystic swelling
Anterior to and below the testis transilluminate
Pathophysiology of communicating hydrocele
Persistence of the processus vaginalis allows peritoneal fluid to communicate freely with the scrotal portion of the processus.
Aetiology of communicating hydrocele
Congenital
Can present in older males as a result of intra-abdominal pressure or fluid overload
Clinical presentation of communicating hydrocele
Scrotal enlargement with a non-tender, smooth cystic swelling
Anterior to and below the testis transilluminate
Vacillates in size and is usually related to ambulation.
Aetiology of non-communicating hydrocele
Imbalance between secretion and reabsorption of fluid.
Also secondary to trauma, torsion.
Epidemiology of hydrocele
1-2% of male neonates
Diagnosis of hydrocele
Ultrasound
Transilluminate
Treatment of hydrocele
Observation for first 2 years
Surgical removal
Complications of hydrocele
Infection.
Depending on underlying pathology; infertility or testicular atrophy due to trauma.
What is a varicocele
Abnormal dilation of the testicular veins in the pampiniform plexus
Pathophysiology of varicocele
Heat generated by varicocele affects sperm quality.
Proteins required for healthy sperm are reduced.
Aetiology of varicocele
Venous reflux.
More common on the left, due to the angle of the left testicular vein entering the left renal vein.
Can be due to problems with the valves causing back-flow of blood.
This causes swelling due to excessive pressure.
Epidemiology of varicocele
Incidence increases after puberty
Clinical presentation of varicocele
Usually asymptomatic.
Scrotum feels like ‘a bag of worms’.
Side affected hangs lower.
Diagnosis of varicocele
Observation
Ultrasound (more accurate)
Treatment of varicocele
If symptomatic, surgery
Avoid if possible as surgery can cause testicular damage
Complications of varicocele
Left untreated , can cause infertility
