Penile and scrotal pathology Flashcards
How to assess a mass of the scrotum
Size Site Shape Symmetry Skin changes/scars
Palpation -Temp -Tenderness -Transillumonation (campfire) -Consistency -Attachments -Mobility -Pulsation -Fluctuation -Irreducibility -Regional lymph nodes -Edges
Painless scrotal lumps
Tumour Haematocele Epiddymal cyst varicocele Hydrocele
Painful scrotal lumps
Strangulated inguinal hernia
Torsion of testis
epididymis-orchitis
What is varicocele
Abnormal dilatation of the testicular veins in the pampiniform plexus caused by venous reflux
-More common on left (those on right are refereed urgently)
Presentation of varicocele
Bag of worms appearance
Lump with a dragging sensation
Disappears on lying down and reappears on standing, ++ with Valsava
Dull ache/painless
Associated with infertility
Management of varicocele
Embolisation or surgical ligation of veins only when
- painful
- Oligospermia
- children
What is hydrocele
Abnormal collection of peritoneal fluid between the parietal and visceral layers of the tunica vaginalis that envelopes the testis
How does hydrocele present
Painless fluctuant swelling that will transilluminate either unilateral or bilateral
Swelling usually occurs anteriorly and below the testis
What is a communicating hydrocele
Persistence of the processes vaginalis allows peritoneal fluid to communicate freely with the scrotal portion of the processus
Mostly congenital but may occur later if increased intra-abdominal pressure, peritoneal dialysis, or fluid overload
What is non communicating hydrocele
Due to imbalance between secretion and reabsorption of fluid
Can occur secondary to minor trauma, testicular torsion, epididymitis
What is a epididymal cyst
Benign fluid filled sacs arising from the epididymis
What is a spermatocele
Benign sperm-filled sacs arising from epididymis
Presentations of spermatoceles or epididymal costs
Chronic onset
Smooth, well defined and fluctuant
Transilluminate
Separately palpable to the testes
Management of spermatoceles or epididymal cysts
None
Only surgery if large or painful
What is epididymo-orchitis
Inflammation of the epididymis and testicle
Cause of epididymis-orchitis
Most common cause in men<35yo, and in men >35yo
Other causes of it
Infection that has spread from urethra or bladder.
Most common cause <35yo= STI (chlamydia
Most common cause >35yo UTI (e.coli, pseudomonas)
Mumps can cause orchitis
Extrapulmonary TV
Presentation of epididymis-orchitis
What is Phren’s sign
Unilateral scrotal pain and swelling Onset over hours/days Oedematous swelling Dysuria Fever Urethral discharge
Phren’s sign- pain relief on elevation of testicles
Management of epididymo-orchitis
Analgesia, scrotal support
Abx
STI screen and abstain from sex
Never be diagnosed in males<15 in absence of UTI symptoms because of torsion
What is testicular torsion
Spermatic cord twists within tunica vaginalis
Leads to occlusion of testicular blood vessels
Compromised blood supply leads to ischaemia
Risk factor for testicular torsion
Bell clapper deformity- lack of normal fixation of the posterior lateral aspect of the testes to the tunica vaginalis
Bell clapper testis- Horizontal lie of the testis rather than vertical
presentation of testicular torsion
Sudden onset pain in one testis makes walking uncomfortable Can be intermittent Can come on during physical activity N&V Abdo pain Inflammation Testis may be high lying and transverse Lifting testis up worsens pain Absent cremasteric reflex
Differential of testiclar torsion
Indirect inguinal hernia that has herniated into scrotum- positive cough impulse and you would not be able to get above the lump indicating it is bowel in origin
testicular cancer types
Germ cell tumour
Non-germ cell tumour
Types of germ cell tumours
Seminoma
Non-seminoma
- Teratoma
- embryonal
- yolk sac tumour
- choriocarcinoma
