Scrotal Swellings

Question 1

Inguinal hernia

Answer 1

• Seperate from testicle
• Soft
• Bowel sounds
• Cannot ‘get above it’
• Cough impulse may be present
• May be reducible

Question 2

Testicular tumours

Answer 2

• Often discrete testicular nodule (may have associated hydrocele)
• Symptoms of metastatic disease may be present
• USS scrotum and serum ADF and βHCG required
• Always treated with orchidectomy

Question 3

Epididymo-orchitis

Answer 3

• Often history of dysuria and urethral discharge
• Swelling may be tender and eased by elevating testicles
• Most causes due to Chlamydia
• Other organsms point to underlying structural abnormality

Question 4

Epididymal cysts

Answer 4

• Single or multiple
• May contain clear or opalescent fluid (spermatoceles)
• Usually over 40 years of age
• Painless
• Soft, fluctuant lump at the top of the testicle
• Lie above and behind testis
• Usually possible to ‘get above’ the lump
• Excised using scrotal approach

Question 5

Hydrocele

Answer 5

• Tunica vaginalis is a membrane around each testicle
• Hydrocele is fluid built up in this membrane
• Non-painful, soft fluctuant swelling
• Often possible to ‘get above’ swelling
• Usually contain clear fluid
• Will often transiluminate
• May be presenting feature of testicular cancer in young men
• Excised using inguinal approach in children and scrotal approach in adults

Question 6

Testicular torsion

Answer 6

• Severe, sudden onset testicular pain
• Risk factors include abnormal testicular lie
• Typically affects adolescents and young males
• Testis tender and pain not eased by elevation
• Urgent srgery indicated, contralateral testis should also be fixed

Question 7

Varicocele

Answer 7

• Varicotesties of the pampiniform plexus
• Soft ‘bag of worms’
• Typically occur on left (because testicular vein drains into renal vein)
• Can cause dragging or soreness
• Usually harmless
• May be presenting feature of RCC
• Affected testis may be smaller and bilateral varicoceles may affect fertility
• Managed conservatively or radiologically if functional impairment considered

Question 8

Testicular cancer

Answer 8

• Non tender (or even reduced sensation)
• Arising from testicle
• Hard without fluctuance or transillumination
• Irregular
• Age 15-40 years