Testes

Question 1

What should you think for testicular lump?

Answer 1

Cancer until proven otherwise

Question 2

What should you think for acute, tender enlargement of testis?

Answer 2

Torsion until proven otherwise

Question 3

How should you examine scrotal masses?

Answer 3

1. Can you get above it? - if you can’t, indirect hernia/hydrocele
2. Is it separate from testes? - yes and cystic, spermatocele. Yes and solid, epididymitis/varicocele
3. Cystic or solid?

Question 4

What is this describing?

Scrotal mass developing in adulthood containing clear or milk fluid. Lies above and behind testes.

Answer 4

Spermatocele

Question 5

What is this describing?

Fluid within the tunica vaginalis. Patent processus vaginalis, resolves during 1st year of life. Common, younger men.

Answer 5

Primary hydrocele

Question 6

What is this describing?

Fluid within the tunica vaginalis. Caused by testes tumour, trauma, or infection.

Answer 6

Secondary hydrocele

Question 7

What is the treatment for hydrocele?

Answer 7

Aspiration or surgery

Question 8

Which pathogens cause epididymo-orchitis?

Answer 8

Chlamydia, E. coli, mumps, gonorrhoea.

Question 9

What is this describing?

Sudden onset tender scrotal swelling, dysuria, sweats/fever.

Answer 9

Epididymo-orchitis

Question 10

What is the treatment for epididymo-orchitis?

Answer 10

1. If <35 - doxycycline for chlamydia, IM ceftriaxone as well for gonorrhoea.
2. If >35 - antibiotics for UTI which is usually associated
3. Analgesia, scrotal support

Question 11

What is this describing and how is it treated?
Dilated veins of the pampiniform plexus, left side more common due to drainage to left renal vein. ‘Bag of worms’, dull ache.

Answer 11

1. Varicocele

2. Reassurance +/- surgery

Question 12

What is this a presentation of?
Sudden onset pain in one testis, walking is uncomfortable. Pain in abdomen, N&V common. Inflammation, heat, swelling in one testis. Lying transversely or riding high, elevating testicle does not relieve pain. Absent cremasteric reflex on affected side.

Answer 12

Testicular torsion

Question 13

What is the investigation and management for suspected testicular torsion?

Answer 13

1. Urgent urological review and surgical exploration without delay by further imaging.
2. Doppler USS may show lack of blood flow.
3. IV morphine
4. Orchidectomy/orchidopexy based on extent of damage to tissue.
5. Untwist testis - if colour is good, return to scrotum and fix to posterior wall, prosthetic ball at later date