Testes pathology

Question 1

Difference between hydroceles + hernias

Answer 1

Hernias will transmit cough impulses, hydroceles won’t
You can ‘get above’ a hydrocele but not a hernia
Testis cannot be palpated with hydrocele
Hernia does not transilluminate with a torch, hydroceles will

Question 2

What is a varicocele + how is it managed?

Answer 2

scrotal swelling that feels like ‘bag of worms’. Conservative management

Question 3

Causes of acute scrotal pain

Answer 3

Epididymitis 
Testicular torsion 
Fournier's gangrene 
Trauma 
Post-vasectomy pain 
Inguinal hernia 
Mumps orchitis 
Testicular cancer 
Referred pain

Question 4

Assessment of acute scrotal pain

Answer 4

Urine dip + culture

STI testing

Question 5

S+S of epididymitis

Answer 5

Localised testicular pain with tenderness + swelling at posterior of testes

Question 6

Management of epididymitis

Answer 6

Abx pending NAAT test
If <35 + at risk of STI = give ceftriaxone + doxycycline
If >35 or low risk of STI = give Levofloxacin
NSAIDs

Question 7

S+S of testicular torsion

Answer 7

acute onset of moderate to severe testicular pain
Profound diffuse tenderness + swelling
Can come on in middle of night
Comes on several hours after physical activity/ mild trauma

Question 8

Assessment + management of ?testicular torsion

Answer 8

Doppler US
Urgent surgical exploration
Manual detorsion if surgery cannot occur within 2 hours
Orchiopexy must be performed to prevent recurrence

Question 9

What is Fournier’s gangrene?

Answer 9

Necrotising fasciitis of perineum which often involves scrotum
Severe pain, starting on anterior abdo wall + migrating to gluteal muscles, scrotum + penis
Tense oedema + blisters, crepitus + SC gas

Question 10

Management of Fournier’s gangrene

Answer 10

Early aggressive surgical debridement

Broad spectrum abx

Question 11

What is epididymo-orchitis?

Answer 11

More advanced epididymitis

Secondary testicular pain + swelling

Question 12

What is the Phren sign?

Answer 12

Manual elevation of scrotum relieves pain = epididymitis

Question 13

How common is testicular cancer?

Answer 13

most common malignancy in men 15-35

Question 14

S+S of testicular cancer

Answer 14

Painless mass

Local symptoms such as pain + heaviness

Question 15

Assessment of ?testicular cancer

Answer 15

US to differentiate tumor from hydrocele or epididymitis
Measure serum tumor markers (bHCG, AFP + LDH)
CT abdo pelvis + CXR

Question 16

Management of local tumour

Answer 16

Radical inguinal orchiectomy

Question 17

How are men with metastatic testicular cancer classified?

Answer 17

International Germ Cell Cancer Collaborative Group

Question 18

What is cryptochordism?

Answer 18

Undescended testes

Question 19

RF for cryptochordism

Answer 19

Fam hx 
Low birth weight 
SGA 
Preterm 
Another genetic abnormality eg hypospadias

Question 20

Complications of cryptochordism

Answer 20

Impaired fertility
Testicular cancer
Testicular torsion

Question 21

When is screening done in the UK for cryptochordism?

Answer 21

Within 72 hours of birth + at 6-8 weeks of age

Question 22

What are retractile testes?

Answer 22

Have descended into scrotum but come to lie in groin due to strong cremasteric reflex
Don’t need treatment

Question 23

What timeline should be followed for bilateral cryptochordism?

Answer 23

At 3 months = refer to surgeon by 6 months at latest

Question 24

What timeline should be followed for unilateral cryptochordism?

Answer 24

At birth = review at 6-8 weeks
6-8 weeks = review at 3 months
3 months = refer to surgeon

Question 25

Pathology of testicular torsion

Answer 25

Inadequate fixation of lower pole of testis to tunica vaginalis
Testes twists on spermatic cord

Question 26

When does irreperable damage occur with testicular torsion?

Answer 26

After 8 hours of ischemia

Question 27

Examination findings for testicular torsion

Answer 27

Absent cremasteric reflex
High riding testis with long axis oriented transversely (bell clapper deformity)
Profound swelling
Can find ‘knot’ superior to testis