Scrotal swelling

Question 1

What is epididymo-orchitis?

Answer 1

infection of the epididymis +/- testes resulting in pain and swelling

Question 2

what usually causes epididymo-orchitis?

Answer 2

local infections from the genital tract e.g. clam or clap or from the bladder
amiodarone

Question 3

What is an important DD of epididymo-orchitis?

Answer 3

testicular torsion - pain affects the entire testis but still hard to differentiate

Question 4

What are the features of epididymo-orchitis?

Answer 4

i. unilateral testicular pain + swelling
ii. urethral discharge
iii. tenderness may be confined to just the epididymis

Question 5

What is the management of epididymo-orchitis?

Answer 5

Unknown organism = ceftriaxone 500mg IM single dose + doxycycline 100mg PO BD for 10-14 days

Question 6

What are the investigations of epididymo-orchitis?

Answer 6

1. Urethral smear (gram stained) - or first pass urine stain
2. Urethral swab for N. gonorrhoea culture + FPU or urethral swab for NAAT
3. MSU + culture
   if there is any doubt between this and TT - urgent surgical exploration

Question 7

What is the pathology underlying testicular torsion?

Answer 7

twist of speramtic cord resulting in necrosis

Question 8

what age group is commonly affected by TT?

Answer 8

10-30yrs

Question 9

What are the features of TT? what might u find on examination?

Answer 9

1. Pain - severe sudden onset, may be referred to lower abdo
2. N + V
3. Exam: swollen ,tender testis retracted upwards, erythema
4. Cremasteric reflex lost -

Question 10

What is the cremasteric reflex?

Answer 10

Normally - rise of ipsilateral testicle when skin on upper medial thigh is stroked
in TT - elevation of testis doesn’t ease the pain

Question 11

What is the management of TT?

Answer 11

Surgical exploration

fix BOTH testis as bell clapper deformity is often bilateral

Question 12

What is bell clapper deformity?

Answer 12

increased investment of tunica vaginalis allows testis to rotate
TV - pouch of serous membrane covering the testis

Question 13

What is a varicocele?

Answer 13

abnormal enlargement of testicular veins

Question 14

What are the features of varicocele?

Answer 14

bag of worms
subfertility
asymmetrical

Question 15

How is a diagnosis of varicocele made?

Answer 15

us

Question 16

What is the management of varicocele?

Answer 16

1. usually conservative
2. Surgery if pain
   Debate as to whether surgery treats infertility

Question 17

What is a hydrocele?

Answer 17

accumulation of fluid in the tunica vaginalis

Question 18

What are the types of hydrocele?

Answer 18

1. Communicating - potency of the processus vaginalis allowing peritoneal fluid to drain into the scrotum
2. Non-communicating - caused by XS fluid production within TV

Question 19

What are the causes of hydrocele?

Answer 19

Epididymo-orchitis
Testicular torsion
Testicular tumours

Question 20

What are the features of hydrocele?

Answer 20

1. SNT swelling of semi-scrotum, usually anterior inferior
2. Swelling confined to scrotum
3. Testsis may be difficult to palpate if large

Question 21

What swelling transilluminates with a pen torch?

Answer 21

hydrocele

Question 22

What is the management of hydrocele?

Answer 22

surgery
adults - Lords or Jabouley procedure
children - transinguinal ligation of PPV

Question 23

what is the most common histopathology of testicular cancer? what can this further be divided into?

Answer 23

Germ cell

i. Seminoma - commonest subtype
ii. Non-seminoma - teratoma, yolk sac, choriocarcinoma, mixed

Question 24

What are RF for testicular cancer?

Answer 24

Cryptorchidism
Infertility
FHx
Klinefelters syndrome 
Mumps orchitis

Question 25

What are the features of testicular cancer?

Answer 25

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

Question 26

How is testicular cancer diagnosed?

Answer 26

US

CT for staging

Question 27

What is the management of testicular cancer?

Answer 27

1. Radical orchidectomy via an inguinal approachh to avoid contaminating scrotal LN drainage
2. Chemo + radio depending on staging and tumour type