Scrotal and testicular lumps Flashcards
What are the differentials of scrotal or testicular lumps?
Hydrocele Varicocele Epididymal cyst Testicular cancer Epididymo - orchitis Inguinal hernia Testicular torsion
What is a hydrocele?
A collection of fluid in the tunica vaginalis that surrounds the testicles.
How will a hydrocele present?
Usually painless Soft, scrotal swelling Testicle is palpable within, Irreducible Transilluminates by shining a torch through the skin
How is a hydrocele managed?
Normally conservative
Surgery (hydrocelectomy) or aspiration + sclerotherapy if large / symptomatic.
What surgery may be done for hydroceles in young children?
ligation of the patent processus vaginalis
What can hydroceles be secondary to in older males?
Trauma
Testicular cancer
Testicular torsion
Epididymo-orchitis
What is a varicocele?
Where the veins in the pampiniform plexus become swollen
What are some complications of a varicocele?
Impaired fertility,
Testicular atrophy - reduction in size and function
What is the pampiniform plexus?
A venous plexus found in the spermatic cord which drains the testes into the testicular vein
Why do most varicoceles occur on the left side?
As the left testicular vein drains into the left renal vein where there is more resistance.
Whereas the right drains directly into the inferior vena cava.
What serious condition may a left sided varicocele indicate and why?
A renal cell carcinoma which obstructs the drainage of the left testicular vein.
What is the role of the pampiniform plexus?
To drain blood from the testes.
Regulate the temperature of the blood entering the tested by absorbing heat from the testicular artery.
This is because there is an optimum temp for the testes to produce sperm
How do varicoceles present?
Throbbing / dull pain or discomfort that is worse on standing
Dragging sensation
Subfertility
On examination
- scrotal mass - feels like a bag of worms - more prominent on standing and disappears when lying down
- asymmetry in testicular size
What tests can be done to aid the diagnosis of varicoceles?
Doppler ultrasound
Semen analysis looking at fertility
Hormonal tests
How are varicoceles managed?
Normally conservatively
Surgery or endovascular embolisation if severe
