Scrotal and Testicular Disease

Question 1

DDx painless scrotal lump?

Answer 1

INTRASCROTAL:
-Hydrocele
-Epididymal cyst
-Varicocoele
-Benign tumour
-Ididopathic scrotal oedema
Malignant:
-Testicular cancer
-Lymphoma
EXTRASCROTAL:
-Inguinal hernia
-Ascites
-Generalised oedema

Question 2

Hx features in scrotal mass workup?

Answer 2

• How / when became aware?
• Precipitating event?
• Pain?
• ?AFx: UTIs, F/C/R, SOB, headaches
• PMHx: ?cryptorchidism

Question 3

Physical exam features in scrotal mass workup?

Answer 3

• Inspection: erythema, oedema, transillumination
• Palpation: size, shape, position, consistency, tenderness, “get above it”
• General:
• > abdo: masses, hernia, liver and spleen
• > lungs: effusion, consolidation
• > LNs
• > neuro if necessary

Question 4

What must be excluded in scrotal lump workup?

Answer 4

Scrotal lump is testicular cancer until proven otherwise

Question 5

What is the acute scrotum?

Answer 5

Clinical syndrome of new onset scrotal pain:
\+/-:
-swelling
-tenderness
-erythema

Question 6

DDx acute scrotum?

Answer 6

• Appendage torsion (appendix testis, epididymis etc)
• Spermatic cord torsion
• Epididymo-orchitis
• Scrotal oedema (inc early Fourrier gangrene)
• Varicocoele
• Intrascrotal mass
• MSK

Question 7

Ix in acute scrotum?

Answer 7

• Urinalysis
• MSU
• Urethral swab / first void culture
• FBE
• U/S w/ doppler