Scrotal Lumps Flashcards
What are the key causes of scrotal lumps?
Hydrocele Varicocele Epididymal cyst Testicular cancer Inguinal hernia Testicular torsion
What is a hydrocele?
Collection of fluid within the tunica vaginalis surrounding the testes
How might someone with a hydrocele present?
Painless scrotal swelling
Testicle palpable within the scrotum
Soft and fluctuant
Irreducible and not bowel sounds-> distinguishes from hernia
Transilluminable -> able to shine torch through skin
What causes hydroceles to occur?
Idiopathic
Testicular cancer
Testicular torsion
Epididymo-orchitis
Trauma
How are hydroceles managed?
Need to exclude testicular cancer-> USS and tumour markers
Conservative management
Surgery/aspiration or scleropathy for larger or symptomatic cases
What are the possible complications which can occur with hydrocele?
Testicular atrophy
Increased risk of internal haemorrhage due trauma because of their increased size
What is a varicocele?
Why do they occur?
Swollen and enlarged pampiniform plexus
Increased resistance in the testicular vein due to incompetent valves which leads to blood flowing back from testicular vein into pampiniform plexus
Which side are varicoceles most likely to occur on and why?
What needs to be ruled out if someone presents with a varicocele on this side?
LEFT
Due to there being increased resistance in the left testicular vein due to it draining into the left renal vein rather than directly into the IVC like the right testicular vein
Need to exclude renal cell carcinoma as cause because it can lead to obstruction of left testicular vein
What is the function of the pampiniform plexus?
What complications can occur with varicoceles due to impairing this function?
Located in spermatic cord and acts to drain the testes and regulate the temperature of blood entering the testes by absorbing heat from testicular artery= testes need to be at optimum temp for producing sperm
THEREFORE:
-varicoceles can lead to impaired fertility due to disrupting the temperature regulation of the testes
How might someone with varicocele present?
Throbbing/dull ache (differentiates from hydrocele)
Pain worse when standing-> increases the pressure and resistance in venous due to gravity
Dragging sensation in testes
Sub-fertility or infertility
What would you expect to find on examination of varicocele?
Bag of worms i.e. swollen pampiniform plexus
Scrotal mass becomes more prominent when standing and disappears when lying down
May have asymmetry in the testicular size if the varicocele has affected the growth of the testicle
What is a red flag sign in varicoceles and what does it indicate?
Varicocele NOT disappearing when lying down
Suggests there is retroperitoneal tumour which is obstructing the drainage of renal vein
What investigations should be done for when varicocele suspected?
US with doppler= confirm diagnosis
Semen analysis if concerns about fertility
Hormonal tests if concerned about function ie.e FSH and test
How would you manage varicocele?
What are the possible complications of varicocele surgery?
Conservatively if uncomplicated
If pain/atrophy/infertility:
- Surgery
- endovascular embolisation
Complications of surgery:
- hydrocele
- ligation of testicular artery leading to atrophy
What is an epididymal cyst?
How does a spermatocele differ?
Fluid filled sac which occurs in the head of the epididymis
Spermatocele= cyst containing sperm
NOTE: both managed the same
