Scrotal Disease

Question 1

What is an epididymal cyst?

Answer 1

A Smooth, extratesticular, spherical cyst in the head of the epididymis

Question 2

What age would an epididymal cyst usually develop?

Answer 2

Around the age of 40

Question 3

What is the presentation of an epididymal cyst?

Answer 3

• Often are multiple and may be bilateral
• Small cysts may remain undetected and asymptomatic
• Once they get large then may be painful
• Well defined and will transluminate since fluid-filled
• Testis is palpable quite separately from the cyst (unlike hydrocele where the testis is palpable within the fluid filled swelling)

Question 4

When would you surgically remove an epididymal cyst?

Answer 4

Only if it is symptomatic and painful

Question 5

What is a hydrocele?

Answer 5

Abnormal collection of fluid within the tunica vaginalis

Question 6

What are the differences between primary and secondary hydroceles?

Answer 6

Primary - more common, larger and usually associated with younger men
Secondary - usually associated with older men

Question 7

What can a secondary hydrocele be secondary to?

Answer 7

• Testis tumour
• Trauma
• Infection
• TB
• Testicular torsion
• Generalised oedema

Question 8

How does a hydrocele present?

Answer 8

Scrotal enlargement with a non-tender, smooth, cystic swelling. Lied anterior to and below the testis and will transilluminate

Question 9

When would a hydrocele present with pain?

Answer 9

If it was infected

Question 10

What investigations would you do in a hydrocele?

Answer 10

• Ultrasound
• Serum alpha-fetoprotein and human chorionic gonadotrophin to help exclude malignant teratomas or other germ cell tumours

Question 11

What is the treatment and management of a hydrocele?

Answer 11

• Resolve spontaneously
• Many of infancy resolve by 2 yrs
• Therapeutic aspiration or surgical removal

Question 12

What is a varicocele?

Answer 12

Abnormal dilation of the testicular veins in the pampiniform venous plexus, caused by venous reflux

Question 13

Where is a varicocele most likely to occur?

Answer 13

Left side more commonly affected - Angle at which the left testicular vein enters the left renal vein - this is due to increased reflux as a result of compression on the renal vein and the lack of effective valves between the testicular and renal veins.

Question 14

What age group would a varicocele be unusual in?

Answer 14

Boys under 10

Question 15

How does a varicocele present?

Answer 15

• Often visible as distended scrotal blood vessels that feel like ‘a bag of worms’
• Patient may complain of a dull ache or scrotal heaviness
• Scrotum hangs lower on the side of the varicocele

Question 16

How is a varicocele treated?

Answer 16

Surgery if there is pain, infertility or testicular atrophy