Scrotal swellings Flashcards
What are the key causes of testicular lumps?
- Hydrocele
- Varicocele
- Epididymal cyst
- Testicular cancer
- Epididymo-orchitis
- Inguinal hernia
- Testicular torsion
What is a hydrocele?
Collection of fluid within tunica vaginalis which surrounds the testes
What examination findings would you expect with a hydrocele?
- Soft, fluctuant, non-tender lump
- Testicle is palpable within lump
- Irreducible and no bowel sounds present in lump
- Can be transilluminated
What causes a hydrocele?
Can be idiopathic OR secondary to:
-Testicular cancer
-Epididymo-orchitis
-Torsion
-Trauma
What is a varicocele?
Occur when veins in pampiniform plexus become swollen
Pampiniform plexus plays a key role in regulating scrotal temperature by absorbing heat from testicular artery
How do varicoceles present?
-90% occur on the left
-Throbbing/dull pain worse on standing
-Dragging sensation
-Sub-/infertility
What examination findings would you expect with a varicocele?
-‘Bag of worms’ mass
-More prominent on standing, disappears when lying flat
What is the most concerning cause of a varicocele?
-Renal cell carcinoma
What is an epididymal cyst?
Cyst at top of testicle
If filled with sperm = spermatocele
What examination findings would you expect with an epididymal cyst?
-Soft, round lump
-Associated with epididymis, separate to testicle
-May be able to transilluminate if large enough
How does testicular cancer typically present?
-Painless, hard lump
-Irregular, non-fluctuant, does not transilluminate
-Rarely gynaecomastia
How does testicular torsion present?
-Firm, swollen testicle
-Elevated testicle
-Absent cremasteric reflex (retraction of testes when inner thigh is stroked)
-Abnormal testicular lie
-Rotation
How should torsion be managed?
-Urgent urology referral + surgical exploration
-Orchidopexy = correction of torsion and fixation of testicle
-Orchidectomy = in cases of necrosis or delayed surgery
What is the anatomy and journey of sperm through the epididymis + testis?
-Epididymis is located at posterior aspect of testicle
-Sperm is stored in testicle, and released into head of epididymis at top of testicle
-Sperm then moves from head, to body, to tail of epididymis and then through vas deferens
What causes epididymo-orchitis?
-E. coli
-Chlamydia
-Gonorrhoea
-Mumps
