Scrotal pathology

Question 1

What is the epididymis?

Answer 1

A narrow, tightly-coiled tube that is attached to each of the testicles

Question 2

At what week of development do the gonads assume the characteristics of the testis (in men)?

Answer 2

7th week

Question 3

Describe testicular descent

Answer 3

caudal migration
leaves abdominal cavity and descends into the scrotum
reaches scrotal sac by end of 8th month

Question 4

What is lack of development of the gonads called?

Answer 4

gonadal agenesis

Question 5

What is incomplete development of the gonads with arrest at a certain phase called?

Answer 5

hypogenesis

Question 6

What is the commonest gonadal abnormality in males?

Answer 6

cryptorchidism - retention of testes in abdomen or arrest of descent at any point along natural pathway

Question 7

What causes ectopic testis?

Answer 7

if testis does not follow the main gubernacular structure but follows one of its subsidiary strands - ends in abnormal position

Question 8

What is the most successful therapy to relocate testis into scrotum in cryptorchidism?

Answer 8

orchiopexy

Question 9

What are patients with cryptorchidism at risk of later in life?

Answer 9

infertility
testicular cancer

Question 10

What age is testicular torsion most common?

Answer 10

12-18 years

Question 11

What is testicular torsion?

Answer 11

the spermatic cord, which provides blood flow to the testicle, rotates and becomes twisted. The twisting cuts off the testicle’s blood supply and causes sudden pain and swelling. Testicular torsion requires surgery right away to save the testicle

Question 12

Testicular torsion signs and symptoms

Answer 12

scrotal pain
sudden onset
unilateral
no precipitating factors
associated with nausea and vomiting
loss of cremasteric reflex of the testicle

Question 13

Testicular torsion differentials

Answer 13

trauma
epididymitis
incarcerated hernia
torsion of appendix testis
torsion of appendix epididymis

Question 14

What investigations are needed in testicular torsion?

Answer 14

none - straight to surgery
if US is done - color doppler shows lack of arterial flow to testis

Question 15

Testicular torsion treatment

Answer 15

surgical exploration
detorsion
fixation/orchiopexy
do contralateral side too to prevent torsion on that side later
if testes non-viable - removal of gland and fixation of contralateral side

Question 16

What causes a communicating hydrocele?

Answer 16

failure of closure of processus vaginalis after descent of the testis
patent processus vaginalis allows fluid to drain into the scrotum around the testis

Question 17

Communicating hydrocele treatment

Answer 17

most resolve in 1st year of life
persist = surgical treatment - ligation of patent processus vaginalis through a small groin incision

Question 18

Hydrocele causes (older)

Answer 18

reaction to epididymo-orchitis
can be secondary to malignancy

Question 19

Scrotal examination of hydrocele

Answer 19

enlarged but painless scrotum
normal spermatic cord can be palpated above a smooth oval swelling
can transilluminate (less likely if long-standing due to fibrosis)

Question 20

How can you tell the difference between a hydrocele and epididymal cysts?

Answer 20

epididymal cysts are normally multiple, nodular on palpation and above and behind the testis
cysts always transilluminate brightly

Question 21

Epididymal cysts treatment

Answer 21

normally best to leave alone unless increasing in size
recurrence is common
operation can result in sterility due to damage to the pathway of sperm

Question 22

What is a varicocele?

Answer 22

veins of pampiniform plexus are dilated and tortuous, producing a swelling in the line of the spermatic cord that resembles a bag of worms

Question 23

What side is a varicocele more common on?

Answer 23

left
right-angles drainage of left testicular vein into the renal vein renders it more liable to stasis

Question 24

Varicocele treatment

Answer 24

ligation of spermatic vein