Testes Flashcards
What are the differentials for testicular pain?
Testicular torsion, Torted hydatid of margagni, Torted epididymal cyst, Epididymo-orchitis, Idiopathic scrotal oedema.
What is a tortid hyatid and why is it significant?
This is a small embryological remnant at the upper pole of the testis.
Torsion of the hydatid is of no consequence in itself except that it presents a similar picture to torsion of the testis. The pain is usually less severe and of a longer duration than a torted testis.
Occasionally the torted hydatid may be palpable or visible as a ‘blue dot’ in the scrotum.
If in doubt then one must explore surgically.
What is an epididymal cyst?`
Smooth fluid filled swelling which develops slowly in the epididymis and may present with a heavy/achey feeling.
More common in middle aged men therefore less likely in paeds.
What is epidymo-orchitis?
This is inflammation of the epididymis and/or testis.
It is usually due to infection, most commonly from a urinary tract infection or a sexually transmitted infection.
What is idiopathic scrotal oedema?
A self limiting condition, characterised by marked oedema +/- erythema. Important to recognise to prevent unnecessary surgical exploration.
Most common under the age of 10. Unknown aetiology.
Tends to resolve in 3 - 5 days. Reassurance and analgesia are the mainstays of treatment.
What is the another name for tortid teste, which teste is it more common in, how is it managed?
Tortid spermatic cord.
More common in the left.
Emeregency surgery.
Describe the route of the testis from its origin to when it descends.
It starts off near the kidneys.
Descends down through the abdomen and out through the deep ring.
Down the inguinal canal, out the superficial ring and into the scrotum.
When does testis development occur and by what age should the testis have descended?
Development starts 6 weeks post conception.
Testis should have descended by 3 months corrected age.
What structure helps to guide the testis during descent?
Gubernaculum (which is the caudal end of the inguinoscrotal ligament)
Define the following terms: undescended, ascended and retractile testis?
Undescended: This is one that is either impalpable or is found in the inguinal region and never made it to the scrotum.
Ascended: The teste has been seen in the scrotum and now is either impalpable or unable to be brought into the scrotum.
Retractile A teste that can be brought down into the scrotum without any difficulty.
What are some of the risks associated with undescended testis?
- Loss of function, meant to be kept at 1 degree below body temperature.
- Increase risk of malignancy.
- More likely to be damaged in trauma if the testis is in the inguinal canal is more likely to be compressed against the pelvic bone.
- Can still become torted and more difficult to examine if undescended.
Describe the management of an undescended testis if it is palpable in the inguinal canal?
Older than 6 months then consent and advise for an orchidopexy:
Under GA perform an inguinal incision and bring the testis down and fix it in the scrotum.
Describe the mangement of an impalpable undescended testis?
When the child is older than 6 months perform an examination under anaesthesia and if still impalpable then proceed to look intra-abdominally for the testis and bring it down if possible.
Describe the management of bilateral undescended testes?
It is possible that the child has a different genotype to their phenotype. One must take a detailed history and consider the use of genetic testing as well as hormone testing.
What is a varicocoele and how does it present?
A varicocele is an abnormal enlargement of the pampiniform venous plexus in the scrotum.
Presents with:
Visible or palpable (able to be felt bag of worms) enlarged vein
Dragging-like or aching pain within scrotum
Feeling of heaviness in the testicle(s)
Atrophy (shrinking) of the testicle(s)
