Scrotal Disorders B&B

Question 1

how does testicular torsion occur and what is the consequence of this?

Answer 1

twisting of the spermatic cord (containing arteries, veins, and ductus deferens) due to failure of the scrotal ligament to limit testes from twisting

veins become compressed because they are thin-walled, but arterial inflow is intact —> testicular engorgement and hemorrhagic infarction

Question 2

what are the 2 subtypes of testicular torsion?

Answer 2

neonatal (rare): occurs because testes are not yet attached to the scrotum

adult (12-18yo): “Bell clapper deformity” (anatomical defect) in which tunica vaginalis covers the spermatic cord and testes such that it is not attached to the scrotum and has increased mobility

Question 3

which reflex is absent when there is testicular torsion?

Answer 3

cremaster reflex - contraction of cremaster muscle and raising of ipsilateral scrotum/testis should occur if the inner thigh is stroked

this sign is absent in patients with testicular torsion

Question 4

absent cremaster reflex in a male patient =

Answer 4

cremaster reflex: contraction of cremaster muscle and raising of ipsilateral scrotum/testis should occur if the inner thigh i stroked

this sign is absent in patients with testicular torsion

Question 5

Pt is a 14yo M presenting to the ED with a painful engorged testicle. What is the likely cause and how will it be treated?

Answer 5

testicular torsion, most likely due to anatomical defect in which tunica vaginalis covers the spermatic cord and testes such that it is not attached to the scrotum (“Bell-clapper deformity”)

tx: detorsion (untwist it) + orchiopexy on BOTH sides (fixation of testicle, must prevent torsion on the contralateral side)

Question 6

varicocele = dilation of the _____ of the spermatic veins

on the left, this may cause “nutcracker effect,” in which the L spermatic vein is compressed between ____ and _____

if this occurs on the right, you should consider ______

Answer 6

varicocele = dilation of the PAMPINIFORM PLEXUS of the spermatic veins (typically on the left)

—> “nutcracker effect” - L spermatic vein compressed between aorta and superior mesenteric artery

on the right, consider renal cell carcinoma invading the renal vein

Question 7

hydrocele

Answer 7

accumulation of fluid in the tunica vaginalis (small, fluid-filled sac attached to the testicle) —> scrotal swelling

Question 8

how can a hydrocele be distinguished from a tumor when a patient presents with scrotal swelling?

Answer 8

hydrocele: accumulation of fluid in the tunica vaginalis (small, fluid-filled sac attached to the testicle)

hydrocele (fluid) will transilluminate with light (via flashlight) while tumor (solid mass) will not

Question 9

contrast the newborn to adult form of hydrocele

Answer 9

hydrocele: accumulation of fluid in the tunica vaginalis (small, fluid-filled sac attached to the testicle) —> scrotal swelling

newborn/communicating form: incomplete closure of processus vaginalis (which should be obliterated to leave only small tunica vaginalis) causing peritoneal fluid to collect, usually resolves spontaneously by 1 year

adult/noncommunicating form: idiopathic, may be secondary to infection/trauma, may become bloody (hematocele)

Question 10

where can spermatoceles be found?

Answer 10

spermatocele = epididymal cyst

found as a mass on top of, but separate from, the testis

usually filled with fluid, so appear black on ultrasound

Question 11

what complications are associated with cryptorchidism?

Answer 11

aka undescended testes

associated with tubular atrophy (—> hypogonadism, sterility) and higher risk of testicular cancer