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Urology > Scrotal lumps > Flashcards

Scrotal lumps Flashcards

1
Q

What should you ask about in the history of a scrotal lump?

A

Time of onset, associated symptoms such as pain, previous episodes

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2
Q

What should inspection of the lump include?

A

The 6Ss

Site, size, shape symmetry, skin changes, scars

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3
Q

When palpating the lump what should be commented on?

A

Tenderness, temperature, transillumination
CAMPFIRE
Consistency, attachments, mobility, pulsation, fluctuation, irreducibility, regional lymph nodes and edge
Also palpate the testis, epididymis and vas deferens

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4
Q

What investigations would you do for someone with a scrotal lump?

A

Ultrasound scan of the scrotum

blood tests and further imaging

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5
Q

Why would you not take a biopsy for testicular cancer?

A

seeding

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6
Q

How is a diagnosis of testicular cancer made?

A

clinical features, ultrasound, histopathological examination of the testis after a orchidectomy

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7
Q

What blood tests are done for testicular cancer?

A

testicular tumour markers- lactate dehydrogenase (LDH), alpha fetoprotein (AFP) and beta-human chorionic gonadotrophin (beta hCG)

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8
Q

How would you assess for widespread pulmonary metastasis in testicular cancer?

A

Chest radiograph

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9
Q

How would you assess for metastasis of the para-aortic lymph nodes and further?

A

CT Scan of the chest- abdomen- pelvis

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10
Q

How can scrotal lumps be classified?

A

Testicular or extra-testicular

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11
Q

What are the extra-testicular scrotal lumps?

A 
Hydrocoele
Varicocoele
Epididymal cyst 
Epididymitis
Inguinal hernia
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12
Q

What are the testicular scrotal lumps?

A

Testicular tumours
Orchitis
Testicular torsion

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13
Q

What is a hydrocoele?

A

Abnormal collection of peritoneal fluid between the parietal and visceral layers of the tunica vaginalis

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14
Q

What are the clinical features of a hydrocoele?

A

Painless
Fluctuant swelling
transilluminates
Unilateral or bilateral

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15
Q

What is a congenital hydrocoele?

A

effects up to 3% of male neonates and regress spontaneously by 1 or 2 years old, in infants they are caused by patent processes vaginalis which required ligation to stop recurrence

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16
Q

What transilluminates?

A

Fluid, solids will not

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17
Q

What can cause hydrocoeles in older males?

A

trauma, infection, malignancy

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18
Q

What is a varicocoele?

A

abnormal dilatation of the pampiniform venous plexus

19
Q

What does a varicocoele look like?

A

A bag of worms with a dragging sensation that may disappear when lying flat

20
Q

In what positions should you examine a varicocoele?

A

Standing up, lying down and valsalva manoeuvre

21
Q

Which side do varicocoeles usually present?

A

The left side as drains directly into the left renal vein rather than the inferior vena cava

22
Q

What are the complications of a varicocoele?

A

infertility, testicular atrophy due to increase in intra-scrotal temperature so should get a seman analysis

23
Q

What are the red flag signs with a varicocoele?

A

acute onset, ride sided or remain when lying flat, should examine abdomen as may be due to renal tumour

24
Q

What is the management?

A

If asymptomatic then no treatment needed, or ligation of spermatic veins and embolisation

25
Q

What is an eididymal cyst?

A

benign fluid filled sacs arising from the epididymis

26
Q

How do epididymal cysts present?

A

smooth fluctuant nodule found above and separate from the testis that will transilluminate, ca be multiple

27
Q

What is the treatment for epididymal cysts?

A

usually do not need treatment as no association with malignancy and rarely have symptoms, operating may cause infertility

28
Q

What is epididymitis?

A

Inflammation of the epididymis

29
Q

What is the presentation of epididymitis?

A

unilateral acute onset scrotal pain, associated swelling, redness, fever, tender and pain which is received by elevation of the testis (prehns sign)

30
Q

What is the treatment of Epididymitis?

A

usually bacterial in origin e.g. STI or enteric organisms so oral antibiotics and analgesia will help

31
Q

How do inguinal hernias pass into the scrotum?

A

External ring

32
Q

How can you examine an inguinal hernia?

A

you cannot get above an inguinal hernia within the scrotum (can not palpate its superior surface) , a cough may exacerbate the swelling, may disappear when lying flat

33
Q

How would testicular cancer present?

A

Painless lump arising from the testis

Firm irregular mass that does not transilluminate

34
Q

How would you diagnose testicular cancer?

A

urgent ultrasound scan and tumour markers

35
Q

How is testicular cancer treated?

A

Radical inguinal orchidectomy and chemotherapy- 90% five year survival rate

36
Q

What is orchitis?

A

inflammation of the testis

37
Q

What causes orchitis?

A

usually mumps

38
Q

what is orchitis usually paired with?

A

Epididymitis

Epididymo-orchitis

39
Q

What is a complication of orchitis?

A

Intra- testicular abscess

40
Q

What is testicular torsion?

A

Twisting of the testis on the spermatic cord causing ischaemia

41
Q

How does testicular torsion present?

A

Sudden onset very severe unilateral scrotal pain with nausea and vomiting, tender, raised and swollen testis with a loss of cremasteric reflex

42
Q

What increases incidence of testicular torsion?

A

Bell clapper deformity

high attachment of tunica vaginalis allowing rotation

43
Q

What is the treatment for testicular torsion?

A

surgical emergency so scrotal exploration and fixation must occur, salvage rates decline after 6 hours

44
Q

What are some examples of benign testicular lesions?

A

Leydig cell tumours, sertoli cell tumours and lipomas or fibromas

Urology (23 decks)

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