Scrotal lumps

Question 1

Differential for lumps in groin/scrotum?

Answer 1

• Inguinoscrotal hernia
• Epidydmal cyst
• varicocele
• Sperm granuloma
• Hydrocele
• Haematocele

Question 2

Epididymal cyst age of development?

Answer 2

• Develop in adulthood

Question 3

Epididymal cyst content?

Answer 3

Contain clear or milky (spermatocele) fluid

Question 4

Epididymal cyst site?

Answer 4

Lie above and behind testis

Question 5

Epididymal cyst management?

Answer 5

Remove if symptomatic

Question 6

Varicocele

Answer 6

Dilated veins of pampiniform plexus

Question 7

Varicocele presentation?

Answer 7

• Feel like a bag of worms in the scrotum
• May be visible dilated veins
• ↓ size on lying down
• Pt. may c/o dull ache
• May lead to oligospermia (↓ fertility)

Question 8

Pathology of primary varicocele

Answer 8

• Left side commoner

- drain into left renal vein

Question 9

Pathology of secondary varicocele

Answer 9

• left renal tumour has tracked down renal vein →

testicular vein obstruction.

Question 10

Management of varicocele?

Answer 10

• Conservative: scrotal support

- Surgical: clipping the testicular vein (open or lap)

Question 11

Sperm Granuloma presentation

Answer 11

Painful lump of extravasated sperm after vasectomy

Question 12

Hydrocele

Answer 12

Collection of serous fluid w/i tunica vaginalis

Question 13

Primary hydrocele?

Answer 13

• assoc. ̄c patent processus vaginalis

- Commoner, larger, tense, younger men

Question 14

Secondary hydrocele?

Answer 14

• Tumour, trauma, infection

- Smaller, less tense

Question 15

Ix of hydrocele?

Answer 15

US testicle to exclude tumour

Question 16

Management of hydrocele?

Answer 16

• May resolve spontaneously
• Surgery
• • Lord’s Repair: plication of the sac
• • Jaboulay’s Repair: eversion of the sac
• Aspiration (recurs)
• • Send fluid for cytology and MC+S

Question 17

Haematocele?

Answer 17

• Blood in the tunica vaginalis
• Hx of trauma
• May need drainage or excision