Scrotal lumps Flashcards
What are the key differentials for a scrotal lump/swelling?
How can you classify these differentials?
Typically painful:
- Epididymo-orchitis
- Testicular torsion
- Varicocele
Typically painless:
- Testicular cancer
- Hydrocele
- Epididymal cyst
- Inguinal hernia
What is a hydrocele?
A collection of fluid within the tunica vaginalis that surround the testes
Describe the examination findings with a hydrocele
- Soft
- Fluctuant
- Non-tender
- Transilluminates
What are the causes of hydrocele?
- Idiopathic
- Secondary to testicular pathology, e.g. epididymo-orchitis, testicular torsion
Describe the management options for a hydrocele
- Conservative (leave it alone) if asymptomatic
- Refer to urology for further management if necessary, e.g. surgery
What is a varicocele?
A varicocele occurs when the veins in the pampiniform plexus become swollen
Give a complication of a varicocele
Fertility problems
90% of varicoceles occur on which side?
Why is this?
Left
Left testicular vein drains into left renal artery (so there is more resistance compared to right hand side, as right testicular vein drains directly into IVC)
Describe the examination findings with a varicocele
- Feels like a “bag of worms”
- May be tender
- More prominent when standing up, disappears when lying down
What should you do about a varicocele which does not disappear on lying down?
Refer urgently to urology - this could signify a tumour obstructing drainage of the renal vein
Describe the management options for a varicocele
- Conservative (leave it alone) if asymptomatic
- Refer to urology for further management if necessary, e.g. surgery
What is an epididymal cyst?
A fluid-filled sac, which occurs at the head of the epididymis
An epididymal cyst containing sperm is known as a…
Spermatocele
Describe the examination findings with a epididymal cyst
- Soft, round mass
- Separate from the testicle (at the top of the scrotum)
- Transilluminates
Describe the management of an epididymal cyst
- Conservative (leave it alone) if asymptomatic
- Refer to urology for further management if necessary, e.g. surgery
