Scrotal Diseases Flashcards
What can cause lumps in the testes?
Testicular tumour: rule this out first
Inguinoscrotal hernia
Epididymal cyst / Spermatocele
Epididymitis
Varicocele
Hydrocele
Orchitis
What is an Inguinoscrotal hernia?
Protrusion of abdominal contents through the inguinal canal and into the scrotum
When palpating the scrotum, what would you feel with an Inguinoscrotal hernia?
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
What is an Epididymal cyst?
Cysts that develop in the epididymis
They contain fluid
Who gets Epididymal cysts?
Adults, after puberty
When palpating the scrotum, what would you feel with an Epididymal cyst?
A mass separate from the actual testicle, above and behind the testicle
Feels cystic
Transillumination can be used
What is the epididymis?
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
How do patients with Epididymal cysts present?
They have noticed a lump on the testes / in the scrotum and are concerned
What is the difference between an Epididymal cyst and a spermatocele?
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
Management of Epididymal cyst or spermatocele?
Remove if symptomatic, if not leave
Management of Inguinoscrotal hernia?
Surgery to repair it
What is epididymitis?
Inflammation of the epididymis causing pain and swelling
When palpating the scrotum, what would you feel with Epididymitis?
Redness, warmth of scrotum
Swelling around epididymis
Separate from testicle, solid mass
What causes epididymitis?
Infection: UTI or STD
Reflux of urine into ejaculatory ducts, causes inflammation + obstruction
Caused by surgery
How can you differentiate between epididymitis and testicular torsion?
The cremasteric reflex is lost in testicular torsion, but preserved in epididymitis
What is the cremasteric reflex?
Elevation of the testicle in response to stroking the upper inner thigh
What are the complications of epididymitis?
Orchitis: inflammation of testicle
Abscess
Testicular infarction
Management of epididymitis?
Antibiotics if infection suspected
Analgesics
Anti-inflammatory drugs
Surgery in severe cases
In what cases would you do surgery to treat epididymitis? What surgery would you do?
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
What is Orchitis?
Inflammation of one or both of the testicles
Causes swollen, painful testicles
What are the clinical features of orchitis?
Haematospermia: blood in semen Haematuria Severe pain Visible swelling of testicle(s) Swelling on inguinal lymph nodes on affected
What are the causes of orchitis?
Infection related to epididymitis (in this case we call it epididymo-orchitis)
STD
Mumps
Ischaemia
How does ischaemic orchitis occur?
Damage to blood vessels in spermatic cord, not enough blood supply to testicle
Treatment of orchitis?
Antibiotics
NSAIDs
Surgical intervention if very severe
When palpating the scrotum, what would you feel with Orchitis?
Large, swollen, warm testicle
What is epididymo-orchitis?
Orchitis that has occurred because of spread of infection from epididymis
What is Varicocele?
When the veins of the pampiniform plexus become dilated
What is the pampiniform plexus?
Network of small veins found in the spermatic cord
Found above, at the back of the testicle
When palpating the scrotum, what would you feel with Varicocele?
Big squidgy veins found at the back of the testicle
Feels like a bag of worms
How do patients with Varicocele present?
Dull ache in scrotum
Infertility
What is hydrocele?
Accumulation of clear serous fluid in the tunica vaginalis
What is the tunica vaginalis?
The most internal membrane surrounding the testicle
When palpating the scrotum, what would you feel with Hydrocele?
What else can you do to prove it is Hydrocele?
Very large scrotum
Fluid accumulation makes it very difficult to feel the testicle
Scrotum feels soft and fluidy
Transillumination
What is Transillumination? What conditions can it be used to diagnose?
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
What is the cause of primary hydrocele?
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
What is the cause of secondary hydrocele?
Trauma
Tumour
Infection
When are men usually affected by primary hydrocele?
When they’re young
Management of hydrocele?
Aspiration
Surgery: plication (removal of tunica vaginalis)
