Scrotal masses (module 5)

Question 1

three arteries contained in the spermatic cord

Answer 1

testicular artery
Cremasteric artery
artery of the ductus deferens

Question 2

three nerves contained in the spermatic cord

Answer 2

genital branch of genitofemoral nerve
ilioinguinal nerve
autonomic nerves

Question 3

three structures in the spermatic cord that aren’t arteries or nerves

Answer 3

pampiniform plexus of testicular veins
lymphatics
processus vaginalis (where present)

Question 4

what is present in the spermatic cord

Answer 4

3 arteries (testicular, cremasteric, artery of the ductus deferens)
3 nerves (genital branch of the genitofemoral nerve, ilioinguinal nerve, autonomic nerves)
3 other structures (pampiniform plexus of the testiuclar veins, lymphatics, processes vaginalis)

Question 5

what does the darts muscle do

Answer 5

retracts the testis if it is cold or during sexual arousal

Question 6

the testis develop as

Answer 6

an out pouching of the abdominal wall

Question 7

tunica vaginalis

Answer 7

produces small amounts of fluid
derived from a peritoneal out pouching called processus vaginalis
mostly regresses

Question 8

high fusion of tunica vaginalis

Answer 8

means the testicles lie loose (bell clapper configuration)

Question 9

bell clapper configuration of the testes

Answer 9

tend to be high riding with a horizontal lie
prone to twisting (torsion)
if present, the condition is bilateral

Question 10

hydrocoele

Answer 10

excess fluid in the tunica vaginalis
may be congenital or acquired (infection/trauma/tumour)

Question 11

function of the scrotum

Answer 11

allows testicles to be kept at a lower temperature than within the body
receives rich blood supply

Question 12

where does the scrotum get its blood supply

Answer 12

from multiple vessels including the external and internal pudendals

Question 13

the scrotum is prone to

Answer 13

large haematomas with trauma and surgical procedures due to rich blood supply and lax and capacious tissues

Question 14

from where do the testicles receive their blood supply

Answer 14

testicular artery (from aorta)
cremasteric artery (from inferior epigastric)
artery of the ductus deferens (from a branch of internal iliac artery)

Question 15

what happens if one of the arterial blood supplies to the testes is compromised

Answer 15

it is often possible to sacrifice one or more testicular vessels with the testis remaining viable

Question 16

where do the lymphatics of the testes drain to

Answer 16

drain along the spermatic cord and back along the gonadal vessels to nodes alongside the great vessels of the abdomen

basically they drain to the retroperitoneum

Question 17

where would testicular cancer typically spread to

Answer 17

spreads to retroperitoneal nodes

Question 18

three main cell types of the testes

Answer 18

spermatogonia
leydig cells (produce testosterone)
Sertoli cells

Question 19

the tunica vaginalis is applied to

Answer 19

the front of the testes

Question 20

the tunica vaginalis contains

Answer 20

a little fluid

Question 21

when the tunica vaginalis produces excessive fluid this is called

Answer 21

a hydrocoele

Question 22

is a scrotal mass a frequent presentation

Answer 22

yes

Question 23

commonest cause of scrotal lumps

Answer 23

hydrocoeles
epididymal cysts
varicocoeles

Question 24

most serious causes of scrotal lumps

Answer 24

testiuclar cancer
incarcerated inguinal hernia

not to be missed!

Question 25

causes of scrotal mass where the cause is within the testis

Answer 25

testicualr tumour
epididymo-orchitis/abscess

Question 26

causes of scrotal mass where the cause is within the epididymis

Answer 26

epididymal cyst

Question 27

causes of scrotal mass where the cause is outside testes/epididymis

Answer 27

varicocoele
spermatocoele
hydrocoele

Question 28

causes of scrotal mass that extend above the scrotum

Answer 28

hernia

Question 29

determining the cause of a scrotal mass based on its location

Answer 29

Question 30

varicocoele is caused by

Answer 30

dilated pampiniform veins of the testis

Question 31

how common are varicocoeles

Answer 31

up to 15% of the population
80% occur on the left side

Question 32

which side do varicocoeles generally occur on

Answer 32

left

Question 33

what damage can a varococoele do

Answer 33

may produce warming of the testes
can reduce quality, mobility and number of sperm
can reduce testicular growth in certain cases
occasionally symptomatic

Question 34

hernia is caused by

Answer 34

weakness/deficiency of the anterior abdominal wall
may be congenital or acquired

Question 35

epididymal cyst

Answer 35

usually asymptomatic and almost always benign

Question 36

spermatocoele

Answer 36

retention cyst of epididymis containing sperm
common after vasectomy
usually asymptomatic

Question 37

approach to determining the cause of a scrotal mass

Answer 37

most scrotal masses can be discriminated on physical examination
U/S is indicated to confirm diagnosis and exclude malignancy - an extension of clinical examination

Question 38

diagnosis that are made more likely if pain is present

Answer 38

torted cyst/torted testes
infected epididymal cyst
epididymo-orchitis/abscess
infected hydrocoele (pyocoele)
incarcerated hernia

Question 39

what is made more likely if you can’t palpate above the lump?

Answer 39

inguinal hernia

Question 40

what diagnosis is made more likely if the mass in compressible and collapsable when supine?

Answer 40

varicocoele
is often described and feeling like a bag of worms

Question 41

what diagnosis is made more likely if the mass transluminates

Answer 41

hydrocoele
epididymal cyst (Chinese lantern appearance)

Question 42

inguinoscortal ultrasound

Answer 42

highly sensitive, specific and reliable and reproducible
should be performed to confirm diagnosis and exclude malignancy

Question 43

what should you exclude before diagnosing hydrocoele

Answer 43

• testicular cancer
• infection/abscess
• trauma/rupture of testes

Question 44

when diagnosing varicocoele it is important to

Answer 44

measure the size of the testes
check the kidney for tumour as kidney tumours occasionally cause varicocoeles

Question 45

when diagnosing testicualr tumours it is also important to

Answer 45

check tumour markers
arrange CT chest/abdomen.pelvis for mets or nodes

Question 46

should you aspirate a hydrocoele

Answer 46

aspiration is rarely indicated as
risks infection
collection rapidly recurs

Question 47

how should you treat a hydrocoele

Answer 47

surgery eg. hydrocoelectomy with plication and/or eversion of tunica vaginalis are used most commonly
recurrence rate is low
post-operative haematoma is a common complication

Question 48

common complication of surgery to treat hydrocoele

Answer 48

haematoma

Question 49

when is treatment needed for varicocoele

Answer 49

if symptomatic
if there is reduction of testicular growth
the role of varococoele repair to treat male factor infertility is contentious

Question 50

epididymal cyst and spermatocoele treatment

Answer 50

treatment rarely indicated unless very large
Excision risks injuring testicular blood supply/causing vas injury (this can lead to chronic scrotal pain, or vas injury can lead to obstruction of sperm transit)

Question 51

treatment of hernia

Answer 51

emergency repair indicated if strngulated/incarcerated
elective repair (open or laparoscopic) offered if reducible

Question 52

serious diagnoses not to be missed include

Answer 52

testicular torsion
testicular tumour
strangulated/incarcerated inguinal hernia