Scrotal mass Flashcards
Hydrocoele
Collection of fluid between visceral and parietal layers of tunica vaginalis of testis
Types of congenital hydrocoele
Communicating hydrocoele
Hydrocoele of cord
Communicating hydrocoele
Fluid hernia, infantile hydrocoele due to patent processus vaginalis
types of acquired hydrocoele
Primary- ass with normal testis and epidydimis
Secondary- ass with scrotal pathology
Primary hydrocoele
Commonest.
occurs in adults
Becuase of descreased absorption linked to lymphatics
May be late presentation post surgery (inguinal hernia repair, varicocelectomy
Differential of hydrocoele
Epididymal cyst
Spermatocoele
Secondary Hydrocoele
Clinical features of communicating hydrocoele
In babies swelling larger when baby cries
Smaller in morning because of postural drainge of fluid from peritoneal cavity to tunica vaginalis and back
Clinical features of primary hydrocoele
Painless cystic crotal swelling which transluminates
Testis usually posterior to fluid but impalpable of large
May not transluminate if tunica thickened or blood in hydrocoele fluid
Clinical features of secondary hydrocoele
Features of small hydrocoele
Treatment of communicating hydrocoele
Patent processus vaginalis may close spontaneously 1-2 years after birth
Herniotomy if it persists
Treatment of primary hydrocoele
Aspiration and sleropathy
Sodium tetracedyl suphate
For small hydrocoele
Aspirate fluid, get layers to adhere and obliterate potential space for fluid filling
Complications of aspiration and scleropathy
Pain, infection, haematoma
Hydrocoelectomy
Eversion of tunica vaginalis
To obliterate potential space for fluid collection
Epididymal cyst
Posterior or superior to testis
Contains clear fluid
Spermatoccoele
Cloudy fluid becuse of spermatozoa
Clinical features of epid.. cyst and spermatocoele
Painless cystic swelling behind or superior to testis
The epididyal cyst transluminates
Treatment of epididymal cyst and spermatocoele
Surgical excision marsupialization
Varicocele
Varicose veins of the pampiniform plexus of the spermatic cord
Most common site of varocele and epidemiology
90% are eft sided
Males 15-20% postpubertal
10% bilateral R sided rare
Etiology of varicocele
Congenital absence of valves in spermatic vein
Nutcracker effect compression of renal vein between aorta and superior mesenteric artery
Right angled junction of left spermatic vein and renal vein versus oblique junction of right spermatic vein and vena cava
Thrombus from RCC causing neoplastic obstrcution of renal vein and IVC
Why is a varicocele associated with infertility
Increase of temp by 1-2 degrees because of retrogase venus blood floidw from abdomen
Venous anoxia interferes with epidymal function
Clinical features of varicocele
Incidental finding in pubertal boys
Pain esp when erect
Infertility
Looks like bag of worms above testis
Examine while standing
Has cough impulse, enhanced by Valsava
Ipsilateral testicular atrophy
