scrotal lumps Flashcards
key causes of scrotal/testicular lumps
hydrocele varicocele epididymal cyst testicular cancer epididymo-orchitis inguinal hernia testicular torsion
hydrocele
collection of fluid within tunica vaginalis
hydrocele - presentation
painless soft scrotal swelling
hydrocele - OE
testicle palpable within hydrocele
soft + fluctuant
irreducible
transilluminated
hydrocele - causes
idiopathic
secondary to
- cancer
- torsion
- epididymo-orchitis
- trauma
hydrocele - Mx
exclude serious cause
conservative mx
surgery or aspiration if large or symptomatic
varicocele
veins in pampiniform plexus become swollen
varicocele - can cause
impaired fertility - disruption of temperature
testicular atrophy
pampiniform plexus
venous plexus found in spermatic cord
drains the testes
drains into testicular vein
role in regulating temperature of testicles
varicocele - why do they happen
increased resistance in testicular vein
incompetent valves allow blood from testicular vein to flow back into pampiniform plexus
where to testicular veins drain into
R –> IVC
L –> L renal vein
varicocele - which side most commonly affected
Left side
what can L sided varicocele infidicate
obstruction of the left testicular vein caused by a renal cell carcinoma
varicocele - presentation
throbbing/dull pain
worse standing
dragging sensation
sub-fertility or infertility
varicocele - OE
bag of worms scrotal mass
more prominent when standing
disappears when lying down
asymmetry between testicle size
varicocele that does not disappear when lying down
raises concern about retroperitoneal tumours obstructing drainage of renal vein
need urgent urology referral
varicocele - Ix to consider
USS with doppler imaging
semen analysis if fertility concerns
hormonal tests if concern re function
varicocele - Mx
conservative if uncomplicated
surgery or embolisation if pain, atrophy, infertility
epididymal cysts
occur at head of epididymis
if contains sperm = spermatocele
epididymal cysts - presentation
felt lump
incidental finding on USS
epididymal cysts - OE
soft, round lump
top of testicle
separate from testicle
