Surgery A

Question 1

Phren’s sign?

Answer 1

A negative Prehn’s sign, or exacerbation of pain upon elevation of the testicle, is one of the clinical features of testicular torsion.

Positive Phren’s is seen in epididymoorchitis, pain improves on elevation.

Question 2

Hydrocele management in adults:

Answer 2

Assess whether the hydrocele may be due to an underlying cause, such as testicular torsion, testicular cancer, epididymo-orchitis, trauma, or varicocele surgery.
Arrange emergency hospital admission or specialist referral, depending on the possible underlying cause.
If the person is 18–40 years of age, or the testis cannot be palpated, arrange an urgent ultrasound scan of the scrotum. See the section on Assessment for more information.

Question 3

Hydrocele management in children?

Answer 3

• Reassure the parents/carers that the hydrocele is likely to resolvewithout treatment by 12 months of age.
• Arrange referral to a paediatric surgeon,the urgency depending on clinical judgement, if:
  • A simple, non-communicating hydrocele either is not decreasing in size, or is still present after 12 months of age.
  • A concomitant inguinal hernia or underlying testicular pathology is suspected.
  • The hydrocele is localized to the spermatic cord.
  • There is also a palpable abdominal mass (suggesting an abdomino-scrotal hydrocele).

Question 4

Varicocele could be what?

Answer 4

Renal cancer need to rule out!