Non-malignant scrotal disease

Question 1

Examples

Answer 1

Epididymal cyst
Hydrocele
Varicocele

Question 2

What is an epididymal cyst

Answer 2

Extratesticular, spherical cysts in the head of the epididymis

Question 3

Clinical presentation of epididymal cyst

Answer 3

Lump
Often multiple and bilateral
Often asymptomatic

Question 4

Aetiology of epididymal cyst

Answer 4

Possibly obstruction of the epididymis

Question 5

Epidemiology of epididymal cyst: onset age

Answer 5

Around 40

Question 6

Diagnosis of epididymal cyst

Answer 6

Ultrasound

Transilluminate

Question 7

Treatment of epididymal cyst

Answer 7

Not usually necessary

Surgical excision

Question 8

What is a hydrocele

Answer 8

Abnormal collection of fluid within the remnants of the processus vaginalis

Question 9

Types of hydrocele

Answer 9

Simple
Communicating
Non-communicating

Question 10

Pathophysiology of simple hydrocele

Answer 10

Accumulation of fluid within tunica vaginalis.

Usually disappears in the first 2 years of life.

Question 11

Aetiology of simple hydrocele

Answer 11

Congenital
Trauma, testicular torsion
Also possibly due to generalised oedema from other cause

Question 12

Clinical presentation of simple hydrocele

Answer 12

Scrotal enlargement with a non-tender, smooth cystic swelling
Anterior to and below the testis transilluminate

Question 13

Pathophysiology of communicating hydrocele

Answer 13

Persistence of the processus vaginalis allows peritoneal fluid to communicate freely with the scrotal portion of the processus.

Question 14

Aetiology of communicating hydrocele

Answer 14

Congenital

Can present in older males as a result of intra-abdominal pressure or fluid overload

Question 15

Clinical presentation of communicating hydrocele

Answer 15

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.

Question 16

Aetiology of non-communicating hydrocele

Answer 16

Imbalance between secretion and reabsorption of fluid.

Also secondary to trauma, torsion.

Question 17

Epidemiology of hydrocele

Answer 17

1-2% of male neonates

Question 18

Diagnosis of hydrocele

Answer 18

Ultrasound

Transilluminate

Question 19

Treatment of hydrocele

Answer 19

Observation for first 2 years

Surgical removal

Question 20

Complications of hydrocele

Answer 20

Infection.

Depending on underlying pathology; infertility or testicular atrophy due to trauma.

Question 21

What is a varicocele

Answer 21

Abnormal dilation of the testicular veins in the pampiniform plexus

Question 22

Pathophysiology of varicocele

Answer 22

Heat generated by varicocele affects sperm quality.

Proteins required for healthy sperm are reduced.

Question 23

Aetiology of varicocele

Answer 23

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.

Question 24

Epidemiology of varicocele

Answer 24

Incidence increases after puberty

Question 25

Clinical presentation of varicocele

Answer 25

Usually asymptomatic.
Scrotum feels like ‘a bag of worms’.
Side affected hangs lower.

Question 26

Diagnosis of varicocele

Answer 26

Observation

Ultrasound (more accurate)

Question 27

Treatment of varicocele

Answer 27

If symptomatic, surgery

Avoid if possible as surgery can cause testicular damage

Question 28

Complications of varicocele

Answer 28

Left untreated , can cause infertility