Scrotal mass Flashcards
An acutely tender, swollen scrotum is X until proven otherwise
Testicular torsion
Symptoms of UTI
Suprapubic pain Dysuria Polyuria Urgency Offensive smelling urine
Symptoms of STI
Suprapubic pain
Offensive discharge
Purulent urethral discharge
A crucial question for testicular cancer?
Does the testis feel heavy?
Things to check for in testicular examination
Is the mass tender Is the lump hard or soft Can you get above the swelling? Does it transluminate Can you palpate the testis, epididymis and spermatic cord?
Can’t get above the scrotal swelling =>
Inguinoscrotal hernia
Most important questions to differentiate a testicular swelling
Is it separate from the testis
Does it transilluminate
Is it tender
Where would you refer a potential testicular tumour?
Urology
Which nodes do the testis drain to?
Paraarotic
Show as a mass in centre of abdomen
First line investigation of testicular tumour
Ultrasound scan of the testes
Which tumour markers would you test for in potential testicular cancer?
aFP => teratoma
bHCG => seminoma
Take them before and after treatment to monitor repsonse
Treatment of testicular cancer
Sperm storage
Orchidectomy
Histology
Radiotherapy
Management of epididymal cyst
Can be conservative
Can drain it
Bag of worms presentation
Varicocele
Can you get above a varicocele?
YES
Which plexus causes the tortuous veins of a varicocele?
The pampiniform plexus
Which scrotal swelling may change in size over the course of the day/strenuous exercise?
Varicocele
Management of varicocele
Scrotal support
Embolisation
Surgical ligation
Sclerotherapy
A hydrocele is…
Transilluminable
Undescernible from the testis
Fluctuant (fluid filled)
A collection of fluid within the tunica vaginalis
Management of hydrocele
Reassure
Drain
If secondary (e.g after infection or trauma), need to treat the underlying condition
Symptoms of epididymo orchitis
Febrile
Sexually active
Painful micturition
Prehn’s positive!
Ix of epididymo-orchitis
Urine dip
GUM (urethral swab)
If systemically unwell, blood cultures
Consider HIV test
Does orchidoplexy reduce cancer risk?
No, but it does mean they are easier to now detect than if they were in the abdomen!
Which testicular tumour is most likely in 20-30yo
Teratoma
What might the SUDDEN appearance of varicocele suggest?
Renal carcinoma, can invade and interrupt drainage, leading to sudden varicocele
Most likely causes of epididymis-orchiditis in <35yo
STI e.g. chlamydia and gonorrhoeae
Most likely cause of epididymis-orchiditis in 35yo
E.coli
What should you consider with testicular and jaw swelling?
Mumps
What is idiopathic scrotal oedema?
Often seem in 6-7yo boys
They really aren’t bothered by it and it just happens
Resolves in 48-72hr
