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Urology YR3 > Scrotal Lumps > Flashcards

Scrotal Lumps Flashcards

1
Q

Inspection of lump - 6 Sā€™s

A
  • Site
  • Size
  • Shape
  • Symmetry
  • Skin changes
  • Scars
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2
Q

Palpation of lump - CAMPFIRE

A
  • Consistency
  • Attachments
  • Mobility
  • Pulsation
  • Fluctuation
  • Irreducibility
  • Regional lymph nodes
  • Edge

+ tenderness, temperature and transillumination

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3
Q

1st line investigation for scrotal lump

A

USS scrotum

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4
Q

Diagnosing testicular cancer, what is after USS?

A
  • Biopsy = NO due to risk of seeding cancer
  • Instead clinical diagnosis, USS and histopathological exam following orchidectomy
  • Bloods for testicular tumours markers should be sent if suspect cancer
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4
Q
A
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5
Q

Testicular cancer tumour markers

A
  • Alpha fetoprotein (AFP)
  • Beta human chorionic gonadotrophin (b-HCG)
  • Lactate dehydrogenase (LDH) - but this is not specific to testicular cancer, will be high when rapidly dividing cells present so any cancer really with high tumour burden
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6
Q

Two classifications of scrotal lumps

A
  • testicular
  • Extra-testicular
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7
Q

Extra-testicular differentials for scrotal lump

A
  • Hydrocele
  • Varicocele
  • Epididymal cyst
  • Epididymitis
  • Inguinal hernia
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8
Q

Testicular differentals for scrotal lumps

A
  • Testicular tumour
  • Testicular torsion
  • Benign testicular lesions
  • Orchitis
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9
Q

What is hydrocele?

A
  • Abnormal collection of peritoneal fluid
  • Between parietal and visceral layers of tunica vaginalis (envelops testes)
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10
Q

Presentation of hydrocele

A
  • Painless fluctuant swelling - ocassionally can grow large and cause discomfort while sitting/walking
  • Transilluminates
  • Uni or bilateral
  • Can also form in spermatic cord and is differential for groin lump
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11
Q

What is congenital hydrocele?

A
  • Affects 3% male neonates
  • Generally regresses spontaneously by 1-2yrs old
  • No treatment typically needed - caused by patient processus vaginalis, may need ligation to stop recurrence
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12
Q

Older male hydroceles causes

A
  • Primary - idiopathic
  • Secondary - infection, trauma, malignancy
  • Those aged 20-40yrs OR if testes cannot be palpated should have urgent USS scan
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13
Q

Transillumination - what is it?

A
  • Shine pen torch from behind scrotal lump
  • Observe whether light travels through
  • Assess whether mass is fluid filled or not - fluid transilluminates, solid wont
  • Hydroceles and epididymal cysts will transilluminate usually
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14
Q

What is varicocele?

A
  • Abnormal dilatation of pampiniform venous plexus within spermatic cord
  • Bag of worms appearance
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15
Q

Presentation of varicoceles

A
  • Lump
  • Feel like bag of worms
  • Dragging sensation
  • May disappear when lay flat - examine lying down, standing and while performing valsalva
16
Q

Where are most varicoceles located and why?

A
  • Left
  • Spermatic vein drains directly into left renal vein (compared to IVC on R)
17
Q

Consequence of varicocele

A
  • Can cause infertility and testicular atrophy
  • Increases intra-scrotal temperature - impaired flow, stasis of warm venous blood
  • So men should undergo semen analysis if varicocele and fertility issues ā€“> refer to urology if abnormal
18
Q

Red flag signs varicocele

A
  • Acute onset
  • Right sided
  • Remain when lying flat

Investigate these urgently - also examine abdo with all varicoceles incase of renal tumour

19
Q

Treatment of varicocele

A
  • If asymptomatic with no red flags - no treatment
  • Surgical - embolisation by interventional radiologist or open/laparascopic ligation of spermatic veins
20
Q

What are epididymal cysts?

A
  • Benign fluid filled sacs
  • Arising from epididymis
  • AKA spermatoceles
21
Q

Presentation of epididymal cyst

A
  • Smooth, fluctuant nodule
  • Above and seperate from testes
  • Transilluminates
  • Often multiple
22
Q

Management epididymal cyst

A
  • No treatment
  • In rare cases if very large/painful may need surgery - avoid in younger men as may lead to infertility
23
Q

Inguinal hernia as scrotal lump

A
  • Can pass into scrotum via external inguinal ring (superficial)
  • Entering inguinal canal initially via internal (deep) inguinal ring (indirect) or through Hesslebachs triangle (direct)
  • Run alongside spermatic cord when in scrotum
24
Q

Examination of scrotal inguinal hernia

A
  • Cannot get above - cannot palpate its superior surface
  • Cough can exacerbate swelling
  • Can disappear when lay flat
  • Assess for strangulation or incarceration
25
Q

Examination for testicular cancer

A
  • Firm
  • Irregular mass
  • No transillumination
26
Q

Deformity associated with testicular torsion

A
  • Bell clapper deformity - high attachment of tunica vaginalis allowing rotation
27
Q

What can form following orchitis?

A
  • Intra-testicular abscess
  • RARE though
  • Will require drainage and occasionally orchidectomy
28
Q
A

Urology YR3 (27 decks)

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