Scrotal Mass

Question 1

Which scrotal masses transluminates

Answer 1

Hydrocele
Epididymal cyst

(Fluid lets light shine through)

Question 2

Which scrotal masses do not transluminate

Answer 2

Tumour
Orchitis
Haematocele
Granuloma

Varicocele
Epididymitis

Question 3

Which scrotal swelling becomes larger when baby cries

Answer 3

Coommunicating hydrocele

Question 4

What is the painless scrotal swelling that transluminates

Answer 4

Primary hydrocele

Question 5

Which special investigations would you use to differentiate between epididymal cyst and hydrocele

Answer 5

US

Question 6

Differentiate between torsion of the testes and torsion of epididymis

Answer 6

Acute vs gradual onset
Severe vs moderate pain
Associated trauma vs less likely (sexual hx)
Cremaster is reflex always absent on affected side vs intact cremasteric
Negative Prehn sign vs positive Prehn sign

Question 7

What manoeuvre makes a vericicele detectable

Answer 7

Valsava manoeuvre

Question 8

What are the management options for a varicocele

Answer 8

1. Open surgical ligation
2. Spermatic vein embolisation
   a) anterograde sclerotherapy : sclerosant injected to cause fibrotic occlusion
   b) Retrograde embolisation: catheter in left spermatic vein to IVC and left renal vein
   c) Laparoscopy: clipping intraperitonealy

Question 9

What are the features of TB epididymitis

Answer 9

Painless
Craggy non tender epididymal mass with normal testes
May be associated sinus onto scrotal skin
Thickened or beaded vascular diferens
On DRE: palpable seminal vesicles and hard prostate

Question 10

What is the standard treatment for TB epididymitis

Answer 10

6 months TB treatment

Question 11

How would you manage testicular torsion

Answer 11

NB it’s an emergency!!!

1. Manual detorsion
   -relieves pain and buys you time for surgery (will need surgery vele),so twist laterally, successful if marked relief
2. Then Emergency surgery
   -Scrotal excision then detorsion -If viable orchidopexy (3 non absorbable sutures), if ischemic remove testicle (orchidectomy)
   Contralateral orchidopexy in all cases - so always fix the other testicle so it doesn’t suffer the same thing

Question 12

From which duct does the appendix testes come from

Answer 12

Mullerian (paramesomephrict) duct

Question 13

From which duct does the appendix epididymis come from

Answer 13

Wolffian (mesonephric) duct

Question 14

Which scrotal condition presents with a blue dot sign

Answer 14

Torsion of testicular or epididymal appendages (appendix)

Question 15

What is the standard treatment for torsion of testicular or epididymal appendages

Answer 15

1. Conservative
2. If unsure, surgical exploration and excision of torted structure
3. No need for contralateral exploration

Question 16

In which scrotal condition do you get relief with elevation of testes

Answer 16

Epididymitis

Question 17

What are the complications of epididymitis

Answer 17

Infertility
Scrotal abscess
Testicular infarction