Scrotal Swellings

Question 1

Usually painless, scrotal heaviness described as a ‘bag of worms’,?

Answer 1

Varicocele

Question 2

what is varicocele?

Answer 2

Dilated veins of the pampiniform venous plexus

Can result in reduced fertility

Question 3

most common cause of reversible infertility?

Answer 3

varicocele

Varicocele prevent the cooling of the blood reaching the testis. This means the testicle is at the body temperature of 37C instead of 35C which is needed for spermatogenesis» Most common cause of reversible infertility.

Question 4

what do you get nutcracker syndrome in?

therefore where do most varicoceles occur?

Answer 4

varicocele

Compression of L renal vein by
aorta and SMA causing a L-side varicocele

L side

Question 5

Ix of Varicocele?

Mx?

Answer 5

USS Scrotum with Doppler studies + US of kidneys

surgical ligation and embolisation

Question 6

what is hydrocele?

Presentation?

Ix?

Mx?

Answer 6

Fluid within the tunica vaginalis

Painless, smooth swelling

Physical examination (transilluminates, testis not separate,It is described as being anterior and below the testicles), 
US

Conservative if hydrocele is small, Aspiration (may need repeating), or surgery to excise hydrocele sac.

Question 7

Epididymal Cyst?

Presentation?

Ix ?

Mx?

-

Answer 7

Cystic swelling arising from the epididymis

Gradual onset of a painless swelling, can be bilateral + multiple

Physical examination (Transilluminates like ‘Chinese lantern’, testis separate from lump), US

Often not indicated, surgical excision if symptomatic

Question 8

Epididymo-Orchitis?

Presentation ?

want to rule out?

if <35 - what is cause?
if older - what is cause?

Ix?

Mx?

Answer 8

Inflammation of the tissues of the epididymis and testis

Acute onset painful unilateral swelling, dysuria, fever, sweats

testicular torsion

If younger (<35y/o) STI is thought to be the cause and if older it is UTI.\

Urethral swab, STI screen, MC&S (MSU), US

<35y/o Doxycycline (chlamydia) or ceftriaxone (gonorrhoea)
>35y/o Ciprofloxacin (UTI)

Question 9

Testicular Tumours

• Presentation?
• Ix?

Mx?

Answer 9

Presentation – Painless scrotal swelling, normally chance discovery, Testis feel heavier.

Ix – Physical examination (craggy, does not transilluminate, +/- hydrocele), US, CT abdo, blood tests (AFP, β-HCG, LDH)

AFP is also increased in HCC

Mx
Radical inguinal orchiectomy
Radiotherapy (seminomas)
Chemotherapy (NSGCT)

Question 10

Testicular Torsion

• presentation?
• Mx?
• classic patient?

if present like torsion but older - what do you suspect?

Answer 10

Sudden onset severe pain in one testis – makes walking uncomfortable. nausea and vomiting

If surgery is performed within <6h – success rate = 90-100%.
Urgent surgery is required for possible orchidectomy or bilateral fixation. (fix BOTH testes to scrotum).

Typically adolescents and young males.

epididymo-orchitis