Scrotal lumps, Torsion

Question 1

Differential for lumps in groin/scrotum?

Answer 1

• Inguinoscrotal hernia
• Epidydmal cyst
• Sperm granuloma
• Varicocele
• 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

Lies 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

Conservative management of varicocele?

Answer 10

scrotal support

Question 11

Surgical mx of varicocele

Answer 11

clipping the testicular vein (open or lap)

Question 12

Cause of sperm granuloma

Answer 12

extravasated sperm after vasectomy

Question 13

Sperm Granuloma presentation

Answer 13

Painful lump

Question 14

Hydrocele

Answer 14

Collection of serous fluid w/i tunica vaginalis

Question 15

Primary vs secondary hydrocele age of presentation?

Answer 15

Primary: Younger men

Question 16

Primary hydrocele sx

Answer 16

larger mass

Painful

Question 17

Secondary hydrocele causes?

Answer 17

Tumour

Trauma

Infection

Question 18

Rx of epidydimo-orchitis

Answer 18

Rx cause

eg STIs: doxycycline/ceftriaxone

Question 19

Secondary hydrocele sx

Answer 19

Smaller

less tense

Question 20

Ix of hydrocele?

Answer 20

US testicle to exclude tumour

Question 21

Management of hydrocele?

Answer 21

• May resolve spontaneously
• Surgery
• Aspiration (recurs) – Send fluid for cytology and MC+S

Question 22

Surgical procedures for hydrocele

Answer 22

Lord’s Repair: plication of the sac

Jaboulay’s Repair: eversion of the sac

Question 23

Haematocele?

Answer 23

• Blood in the tunica vaginalis

Question 24

Haematocele mx

Answer 24

may need drainage or excision

Question 25

Cause of testicular torsion

Answer 25

Usually secondary to minor injury

Question 26

Presentation of testicular torsion

Answer 26

Usually 10-25yrs

Sudden onset severe pain in one testis

May have lower abdominal pain (testis supplied by T10)

Nausea/vomiting

May have history of previous testicular pain or torsion

Question 27

Examination of testicular torsion

Answer 27

Inflammation of one testis: hot, swollen, extremely tender

Testis rides high and lies transversely

Question 28

Differential diagnoses of testicular torsion

Answer 28

1. Epididymo-orchitis
2. Torted Hydatid of Morgagni
3. Tumour
4. Trauma
5. Strangulated hernia
6. Appendicitis

Question 29

Torted hydatid of Morgagni

Answer 29

Remnant of Mullerian duct

Younger patient

Less pain

Tiny blue dot visible on scrotum

Question 30

Epididymo-orchitis presentation

Answer 30

Sudden onset

Tender swelling

Dysuria

Sweats/fever

Question 31

Epididymo-orchitis pathogens

Answer 31

E coli

Chlamydia

N gonnorrhoea

TB

Question 32

Rx of epididymo-orchitis

Answer 32

Rx cause

eg STIs docy/ceftriaxone

Question 33

Investigation of testicular torsion

Answer 33

Doppler ultrasound may demonstrate absence of flow but must not delay surgical exploration

Question 34

Treatment of testicular torsion

Answer 34

Surgical emergency

4-6h window from onset of pain to salvage testis

Inform senior

Consent for possible orchidectomy

Bilateral orchidopexy: suture testes to scrotum

If no torsion found and epididymo-orchitis: take fluid sample from scrotum for bacteriology and treat with antibiotics.