Scrotal pathology Flashcards
What is the epididymis?
A narrow, tightly-coiled tube that is attached to each of the testicles
At what week of development do the gonads assume the characteristics of the testis (in men)?
7th week
Describe testicular descent
caudal migration
leaves abdominal cavity and descends into the scrotum
reaches scrotal sac by end of 8th month
What is lack of development of the gonads called?
gonadal agenesis
What is incomplete development of the gonads with arrest at a certain phase called?
hypogenesis
What is the commonest gonadal abnormality in males?
cryptorchidism - retention of testes in abdomen or arrest of descent at any point along natural pathway
What causes ectopic testis?
if testis does not follow the main gubernacular structure but follows one of its subsidiary strands - ends in abnormal position
What is the most successful therapy to relocate testis into scrotum in cryptorchidism?
orchiopexy
What are patients with cryptorchidism at risk of later in life?
infertility
testicular cancer
What age is testicular torsion most common?
12-18 years
What is testicular torsion?
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
Testicular torsion signs and symptoms
scrotal pain
sudden onset
unilateral
no precipitating factors
associated with nausea and vomiting
loss of cremasteric reflex of the testicle
Testicular torsion differentials
trauma
epididymitis
incarcerated hernia
torsion of appendix testis
torsion of appendix epididymis
What investigations are needed in testicular torsion?
none - straight to surgery
if US is done - color doppler shows lack of arterial flow to testis
Testicular torsion treatment
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
What causes a communicating hydrocele?
failure of closure of processus vaginalis after descent of the testis
patent processus vaginalis allows fluid to drain into the scrotum around the testis
Communicating hydrocele treatment
most resolve in 1st year of life
persist = surgical treatment - ligation of patent processus vaginalis through a small groin incision
Hydrocele causes (older)
reaction to epididymo-orchitis
can be secondary to malignancy
Scrotal examination of hydrocele
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)
How can you tell the difference between a hydrocele and epididymal cysts?
epididymal cysts are normally multiple, nodular on palpation and above and behind the testis
cysts always transilluminate brightly
Epididymal cysts treatment
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
What is a varicocele?
veins of pampiniform plexus are dilated and tortuous, producing a swelling in the line of the spermatic cord that resembles a bag of worms
What side is a varicocele more common on?
left
right-angles drainage of left testicular vein into the renal vein renders it more liable to stasis
Varicocele treatment
ligation of spermatic vein
