Scrotal Diseases

Question 1

What can cause lumps in the testes?

Answer 1

Testicular tumour: rule this out first

Inguinoscrotal hernia

Epididymal cyst / Spermatocele

Epididymitis

Varicocele

Hydrocele

Orchitis

Question 2

What is an Inguinoscrotal hernia?

Answer 2

Protrusion of abdominal contents through the inguinal canal and into the scrotum

Question 3

When palpating the scrotum, what would you feel with an Inguinoscrotal hernia?

Answer 3

Enlarged scrotum

Roll the testes between your fingers

If you can’t get above it (there’s a mass above it), it is likely to be an Inguinoscrotal hernia

Question 4

What is an Epididymal cyst?

Answer 4

Cysts that develop in the epididymis

They contain fluid

Question 5

Who gets Epididymal cysts?

Answer 5

Adults, after puberty

Question 6

When palpating the scrotum, what would you feel with an Epididymal cyst?

Answer 6

A mass separate from the actual testicle, above and behind the testicle

Feels cystic

Transillumination can be used

Question 7

What is the epididymis?

Answer 7

A ‘C’ shaped network of ducts, the bit that sort of holds onto the testicle.

The ducts take the sperm from the testicle to the vas deferens where they go out of the penis during ejaculation

Question 8

How do patients with Epididymal cysts present?

Answer 8

They have noticed a lump on the testes / in the scrotum and are concerned

Question 9

What is the difference between an Epididymal cyst and a spermatocele?

Answer 9

Both are fluid filled cysts on the epididymis.

Epididymal cyst refers to a cyst filled with clear fluid

Spermatocele contains milky fluid that contains sperm

Question 10

Management of Epididymal cyst or spermatocele?

Answer 10

Remove if symptomatic, if not leave

Question 11

Management of Inguinoscrotal hernia?

Answer 11

Surgery to repair it

Question 12

What is epididymitis?

Answer 12

Inflammation of the epididymis causing pain and swelling

Question 13

When palpating the scrotum, what would you feel with Epididymitis?

Answer 13

Redness, warmth of scrotum
Swelling around epididymis

Separate from testicle, solid mass

Question 14

What causes epididymitis?

Answer 14

Infection: UTI or STD

Reflux of urine into ejaculatory ducts, causes inflammation + obstruction

Caused by surgery

Question 15

How can you differentiate between epididymitis and testicular torsion?

Answer 15

The cremasteric reflex is lost in testicular torsion, but preserved in epididymitis

Question 16

What is the cremasteric reflex?

Answer 16

Elevation of the testicle in response to stroking the upper inner thigh

Question 17

What are the complications of epididymitis?

Answer 17

Orchitis: inflammation of testicle

Abscess

Testicular infarction

Question 18

Management of epididymitis?

Answer 18

Antibiotics if infection suspected

Analgesics

Anti-inflammatory drugs

Surgery in severe cases

Question 19

In what cases would you do surgery to treat epididymitis? What surgery would you do?

Answer 19

In acute suppurating epididymitis (pus forming)
- Epididymotomy to drain the pus

In untreatable cases: epididymectomy (removal of epididymis

In cases of severe uncontrollable pain: orchiectomy

Question 20

What is Orchitis?

Answer 20

Inflammation of one or both of the testicles

Causes swollen, painful testicles

Question 21

What are the clinical features of orchitis?

Answer 21

Haematospermia: blood in semen
Haematuria
Severe pain
Visible swelling of testicle(s)
Swelling on inguinal lymph nodes on affected

Question 22

What are the causes of orchitis?

Answer 22

Infection related to epididymitis (in this case we call it epididymo-orchitis)

STD

Mumps

Ischaemia

Question 23

How does ischaemic orchitis occur?

Answer 23

Damage to blood vessels in spermatic cord, not enough blood supply to testicle

Question 24

Treatment of orchitis?

Answer 24

Antibiotics

NSAIDs

Surgical intervention if very severe

Question 25

When palpating the scrotum, what would you feel with Orchitis?

Answer 25

Large, swollen, warm testicle

Question 26

What is epididymo-orchitis?

Answer 26

Orchitis that has occurred because of spread of infection from epididymis

Question 27

What is Varicocele?

Answer 27

When the veins of the pampiniform plexus become dilated

Question 28

What is the pampiniform plexus?

Answer 28

Network of small veins found in the spermatic cord

Found above, at the back of the testicle

Question 29

When palpating the scrotum, what would you feel with Varicocele?

Answer 29

Big squidgy veins found at the back of the testicle

Feels like a bag of worms

Question 30

How do patients with Varicocele present?

Answer 30

Dull ache in scrotum

Infertility

Question 31

What is hydrocele?

Answer 31

Accumulation of clear serous fluid in the tunica vaginalis

Question 32

What is the tunica vaginalis?

Answer 32

The most internal membrane surrounding the testicle

Question 33

When palpating the scrotum, what would you feel with Hydrocele?

What else can you do to prove it is Hydrocele?

Answer 33

Very large scrotum
Fluid accumulation makes it very difficult to feel the testicle
Scrotum feels soft and fluidy

Transillumination

Question 34

What is Transillumination? What conditions can it be used to diagnose?

Answer 34

When light is shone through the affected part of the scrotum and it is seen on the other side as red.

Hydrocele: because the fluid is clear
Spermatocele

Question 35

What is the cause of primary hydrocele?

Answer 35

A linkage (processus vaginalis) between the peritoneal tissue and the tunica vaginalis fails to be obliterated as it should be during embryogenesis

So fluid from the peritoneum accumulates in the tunica vaginalis

Question 36

What is the cause of secondary hydrocele?

Answer 36

Trauma
Tumour
Infection

Question 37

When are men usually affected by primary hydrocele?

Answer 37

When they’re young

Question 38

Management of hydrocele?

Answer 38

Aspiration

Surgery: plication (removal of tunica vaginalis)