Scrotal disease

Question 1

what is a hydrocele

Answer 1

accumulation of fluid in space surrounding testicle

Question 2

cause of hydroceles

Answer 2

majority are congenital seen in boys aged 1-2. most resolve by 1st yr of life

sometimes occur in >40yo (trauma, infection, tumour,, torsion)

Question 3

sx hydrocele

Answer 3

painless, enlarged scrotom. testicle may or may not be palpable depending on size

Question 4

ix hydrocele

Answer 4

will transilluminate. further ix not required in children

USS in adults to look for pathology

Question 5

rx hydrocele infants

Answer 5

CHILDREN
- usually just observation unless inguinal hernia or testicular pathology
ADULTS
-surgery if larger or tumour suspected. not needed if only small.

Question 6

what is a varicocoele

Answer 6

abnormal enlargement of pampiniform venous plexus in the scrotum

Question 7

causes of varicocoele

Answer 7

idiopathic (15-30% of all males!)

-secondary: due to compression

Question 8

why worry with new unilateral right sided varicocoele in pt over 40

Answer 8

renal malig

Question 9

what side are idiopathic varicocoeles usually on

Answer 9

left (if on right worry about malig!!)

mum is left handed and favourite colour is blue

Question 10

what is nutcracker syndrome?

Answer 10

condition in which the superior mesenteric artery compresses the left renal vein (because the artery travels over the vein), causing increased pressure to be transmitted retrograde into the left pampiniform plexus

Question 11

clinical features of varicocoele

Answer 11

• bag of worms, prominent when standing
• dragging
• atrophy of testicle
• BPH+LUTS (blood gets congested so drains through the prostate)
• infertility

Question 12

ix varicocoele

Answer 12

USS

Question 13

rx varicocoele

Answer 13

if no pain: no rx

• surgery: varicoele ligation
• embolisation (by radiologist - small metal coil in vein to block it off)

Question 14

sx epididymal cyst

Answer 14

lump (causes great deal of anxiety)

often multiple and bilateral

Question 15

findings on exam of epididymal cyst

Answer 15

• well defined lump
• transilluminates
• testis palpable separately from the cyst (unlike hydrocele where testis is palpable within the fluid filled swelling)

Question 16

how to know epididymal cyst is not a tumour

Answer 16

extratesticular, fluctuant, cystic swelling which transilluminates and is palpable separate from the body of the testis DO NOT NEED FURTHER IX

Question 17

ix if epididymal cyst diagnosis uncertain

Answer 17

USS

don’t need ix if sure epididymal cyst on examination

Question 18

rx epididymal cyst

Answer 18

not usually necessary.
safety net: if painful or start increasing in size -> seek med advice
can have excised if really want

Question 19

what is a spermatocele

Answer 19

cysts which feels like epididymal cyst but is filled with sperm
no way to clinically differenttiate. can aspirate to see if fluid is milky but this is not recommended as it does not change management

Question 20

congenital malformation that causes torsion

Answer 20

bell clapper deformity (outside of testis joins high on spermatic cord so testis can rotate more easily)