Scrotal lumps Flashcards
Inspection of the lump 6 S’s
Site Size Shape Symmetry Skin change Scars
Palpating the lump (CAMPFIRE)
Consistency
Attachments
Mobility
Pulsation
Fluctuation
Irreducibility
Regional lymph nodes
Edge
Also:
Tenderness
Temperature
Transillumination
Investigations
USS - first line
Blood test - tumour markers e.g. beta HCG, AFP, LDH
Biopsy
Biopsy is not warranted for the diagnosis of testicular cancer (due to risk of seeding cancer)
Scrotal lumps
Hydrocoele Varicocoele Epididymal Cysts Epididymitis Inguinal hernia Testicular tumour
Hydrocoele
Abnormal collection of peritoneal fluid in the tunica vaginalis
- painless fluctuant swelling
- transilluminate
- between 20-40yrs - undergo urgent ultrasound scan
Causes of hydrocoele
Primary
Secondary - trauma, infection or malignancy
Varicocoele
Abnormal dilatation of the pampiniform venous plexus within the spermatic cord
- bag of worms
- dragging sensation
- may disappear on lying flat
- commonly on left
Complications of varicocoeles
Infertility
Testicular atrophy
Red flags for varicocele
Acute onset
Right-sided
Remain when lying flat
Investigated urgently
Mx of varicocele
Infertility - semen analysis
Mx:
Asymptomatic varicocoeles with no red flags - no treatment
Surgical:
- embolisation
- open or laparoscopic approach for ligation of the spermatic veins
Epididymal Cysts
Benign fluid-filled sacs arising from the epididymis
- smooth fluctuant nodule
- separate from the testis
- transilluminate
- can have multiple
- seen in middle aged men
- Do not require treatment
- Surgery if large and painful
Epididymitis
Inflammation of the epididymis commonly due to bacteria - STI or enteric
- unilateral acute onset scrotal pain
- may have associated swelling, erythematous overlying skin, and systemic symptoms such as fever
- tender epididymis
- Prehn’s sign
Prehn’s sign
pain may be relieved on elevation of the testis
Mx of epididymitis
Oral antibiotics and analgesia
Testicular Tumours
Painless lump arising from the testis
- firm irregular mass
- does not transilluminate
Ix: urgent ultrasound scan
Bloods - tumour markers
Mx of testicular tumours
High index of suspicion - radical inguinal orchidectomy
Adjuvant chemotherapy
Testicular Torsion
Twisting of the testis on the spermatic cord causing ischaemia.
- sudden-onset
- very severe
- unilateral scrotal pain
- associated nausea or vomiting
- ‘Bell-clapper’ deformity
- affected testis is usually extremely tender, raised, and swollen
- loss of cremasteric reflex
Mx of testicular Torsion
Surgical emergency - fixation of both testes within 6 hours
Benign Testicular Lesions
Leydig cell tumours
Sertoli cell tumours
Lipomas
Fibromas
Orchitis
Inflammation of the testis commonly caused by mumps
Tx - rest and analgesia
Rare complication:
Intra-testicular abscess - requires drainage
Investigations for scrotal pain
Urine dipstick - urinalysis + MCS
Urethral swab STI
Routine bloods
USS of scrotum
Henoch-Schoenlein Purpura
IgA-mediated small vessel vasculitis
Commonly affects the skin, mucous membranes, and kidneys.
Triad:
- purpuric rash on limbs
- arthritis
- abdominal pain
