Scrotal swelling/pain Flashcards
5 layers of the scrotum
skin dartis muscle 3 fascial layers tunica vaginalis tunica albuginea
4 contents of the spermatic cord
vas deferens
tesitcular artery
nerves
vein
Important questions in Hx (4)
SOCRATES
trauma
fever/dysuria
previous episodes of pain>intermittent torsion
Hydrocele definition and subtypes (3)
fluid within tunica vaginalis
Primary-due to patent processus vaginalis. usually resolves w/i 1 yr so don’t Rx pt. if <12mo
Secondary-due to tumour, trauma or infection
Features of hydroceles (2)
not felt separately (DDx from epididymal cysts)
trans-illuminates (DDx from tumour)
Rx for hydroceles (3)
if not bothering pt. then wait;may resolve spontaneously
aspiration-risk of recurrence
surgery-tighten tunica vaginalis
Definition, features, Rx of haematocele (3)
blood in tunica vaginalis
usually follows trauma
may need drainage/excision
Features of epididymal cysts (6)
most common testicular swelling separate from testes;usually above and behind transilluminates smooth contain clear/milky spermatocele fluid develop in adulthood
Conditions assoc. w. epididymal cysts
CF
PCKD
vHL syndrome
Rx of epididymal cysts
remove only if symptomatic
Features and Ex of inguinoscrotal hernias (4)
cannot get above it
direct or indirect
attempt to reduce standing and supine
check cough impulse
Varicocele definition and features (6)
dilated veins in pampiniform plexus feel like bag of worms get larger when standing may have dull ache left side more commonly affected (80%) unresolved left-sided varicocele can be due to RCC compressing left renal vein
complications of varicoceles (2)
testicular atrophy
subfertility
Rx of varicoceles (2)
reassure if not problematic
otherwise repair via surgery/embolisation
Prehn’s test?
pain relieved by lifting testes in epididymitis
Causes of epididymo-orchitis (6)
young people: chlamydia then gonorrhoea older: e. coli, klebsiella, pseudomonas, proteus TB mumps amiodarone-ceases after stopping drug post-cytoscopy
Presentation of epididymo-orchitis (5)
sudden onset of redness, swelling and warmth
Hx of exposure to infection
dysuria
fever/sweats
cremasteric reflex present (not in torsion)
Ix for epididymo-orchitis (2)
urine leucocytes
STI screen
Rx of epididymo-orchitis
if<35: doxycycline , IM ceftriaxone if gonorrhoea suspected
if>35: ciprofloxacin
give Abx for 2-4wks
complications of epididymo-orchitis
subfertility
Vasculitic causes of testicular pain/swelling (3)
HSP
Kawasaki
Buerger’s
Ix for cryptorchidism
MRI to check position
Mx of cryptorchidism (2)
by 1yr 2/3 spontaneously descend
otherwise do orchidopexy before 2yrs to prevent subfertility (similar procedure for torsion)
complications of cryptorchidism
increased risk of testicular ca.
RFs for torsion (2)
clapper bell deformity
cryptorchidism
