Testes pathology Flashcards
Difference between hydroceles + hernias
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
What is a varicocele + how is it managed?
scrotal swelling that feels like ‘bag of worms’. Conservative management
Causes of acute scrotal pain
Epididymitis Testicular torsion Fournier's gangrene Trauma Post-vasectomy pain Inguinal hernia Mumps orchitis Testicular cancer Referred pain
Assessment of acute scrotal pain
Urine dip + culture
STI testing
S+S of epididymitis
Localised testicular pain with tenderness + swelling at posterior of testes
Management of epididymitis
Abx pending NAAT test
If <35 + at risk of STI = give ceftriaxone + doxycycline
If >35 or low risk of STI = give Levofloxacin
NSAIDs
S+S of testicular torsion
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
Assessment + management of ?testicular torsion
Doppler US
Urgent surgical exploration
Manual detorsion if surgery cannot occur within 2 hours
Orchiopexy must be performed to prevent recurrence
What is Fournier’s gangrene?
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
Management of Fournier’s gangrene
Early aggressive surgical debridement
Broad spectrum abx
What is epididymo-orchitis?
More advanced epididymitis
Secondary testicular pain + swelling
What is the Phren sign?
Manual elevation of scrotum relieves pain = epididymitis
How common is testicular cancer?
most common malignancy in men 15-35
S+S of testicular cancer
Painless mass
Local symptoms such as pain + heaviness
Assessment of ?testicular cancer
US to differentiate tumor from hydrocele or epididymitis
Measure serum tumor markers (bHCG, AFP + LDH)
CT abdo pelvis + CXR
Management of local tumour
Radical inguinal orchiectomy
How are men with metastatic testicular cancer classified?
International Germ Cell Cancer Collaborative Group
What is cryptochordism?
Undescended testes
RF for cryptochordism
Fam hx Low birth weight SGA Preterm Another genetic abnormality eg hypospadias
Complications of cryptochordism
Impaired fertility
Testicular cancer
Testicular torsion
When is screening done in the UK for cryptochordism?
Within 72 hours of birth + at 6-8 weeks of age
What are retractile testes?
Have descended into scrotum but come to lie in groin due to strong cremasteric reflex
Don’t need treatment
What timeline should be followed for bilateral cryptochordism?
At 3 months = refer to surgeon by 6 months at latest
What timeline should be followed for unilateral cryptochordism?
At birth = review at 6-8 weeks
6-8 weeks = review at 3 months
3 months = refer to surgeon
Pathology of testicular torsion
Inadequate fixation of lower pole of testis to tunica vaginalis
Testes twists on spermatic cord
When does irreperable damage occur with testicular torsion?
After 8 hours of ischemia
Examination findings for testicular torsion
Absent cremasteric reflex
High riding testis with long axis oriented transversely (bell clapper deformity)
Profound swelling
Can find ‘knot’ superior to testis
