Scrotal swelling Flashcards
What is epididymo-orchitis?
infection of the epididymis +/- testes resulting in pain and swelling
what usually causes epididymo-orchitis?
local infections from the genital tract e.g. clam or clap or from the bladder
amiodarone
What is an important DD of epididymo-orchitis?
testicular torsion - pain affects the entire testis but still hard to differentiate
What are the features of epididymo-orchitis?
i. unilateral testicular pain + swelling
ii. urethral discharge
iii. tenderness may be confined to just the epididymis
What is the management of epididymo-orchitis?
Unknown organism = ceftriaxone 500mg IM single dose + doxycycline 100mg PO BD for 10-14 days
What are the investigations of epididymo-orchitis?
- Urethral smear (gram stained) - or first pass urine stain
- Urethral swab for N. gonorrhoea culture + FPU or urethral swab for NAAT
- MSU + culture
if there is any doubt between this and TT - urgent surgical exploration
What is the pathology underlying testicular torsion?
twist of speramtic cord resulting in necrosis
what age group is commonly affected by TT?
10-30yrs
What are the features of TT? what might u find on examination?
- Pain - severe sudden onset, may be referred to lower abdo
- N + V
- Exam: swollen ,tender testis retracted upwards, erythema
- Cremasteric reflex lost -
What is the cremasteric reflex?
Normally - rise of ipsilateral testicle when skin on upper medial thigh is stroked
in TT - elevation of testis doesn’t ease the pain
What is the management of TT?
Surgical exploration
fix BOTH testis as bell clapper deformity is often bilateral
What is bell clapper deformity?
increased investment of tunica vaginalis allows testis to rotate
TV - pouch of serous membrane covering the testis
What is a varicocele?
abnormal enlargement of testicular veins
What are the features of varicocele?
bag of worms
subfertility
asymmetrical
How is a diagnosis of varicocele made?
us
What is the management of varicocele?
- usually conservative
- Surgery if pain
Debate as to whether surgery treats infertility
What is a hydrocele?
accumulation of fluid in the tunica vaginalis
What are the types of hydrocele?
- Communicating - potency of the processus vaginalis allowing peritoneal fluid to drain into the scrotum
- Non-communicating - caused by XS fluid production within TV
What are the causes of hydrocele?
Epididymo-orchitis
Testicular torsion
Testicular tumours
What are the features of hydrocele?
- SNT swelling of semi-scrotum, usually anterior inferior
- Swelling confined to scrotum
- Testsis may be difficult to palpate if large
What swelling transilluminates with a pen torch?
hydrocele
What is the management of hydrocele?
surgery
adults - Lords or Jabouley procedure
children - transinguinal ligation of PPV
what is the most common histopathology of testicular cancer? what can this further be divided into?
Germ cell
i. Seminoma - commonest subtype
ii. Non-seminoma - teratoma, yolk sac, choriocarcinoma, mixed
What are RF for testicular cancer?
Cryptorchidism Infertility FHx Klinefelters syndrome Mumps orchitis
What are the features of testicular cancer?
i. Painless lump
ii. Feeling of heaviness in the scrotum
iii. Pain CAN be present in few
iv. Hydrocele
v. Gynaecomastia - due to B-hCG
vi. Raised AFP + LDH
alpha-fetoprotein + lactate dehydrogenase - tumour markers
How is testicular cancer diagnosed?
US
CT for staging
What is the management of testicular cancer?
- Radical orchidectomy via an inguinal approachh to avoid contaminating scrotal LN drainage
- Chemo + radio depending on staging and tumour type
