Testicular and Scrotal Disorders

Question 1

What are the causes of painless scrotal swellings?

Answer 1

Transillumination +ve:
-Hydrocele and spermatocele

Transillumination -ve:
-Hernia and testicular tumor

Question 2

What are the causes of painful scrotal swellings?

Answer 2

Post traumatic doesn’t improve with elevation of testis:
-Testicular torsion and hematocele

Not Post traumatic improves with elevation of testis:
-Inflammation and varicocele

Question 3

What are the differentials and treatment of hydrocele?

Answer 3

-Differentials: Large and can’t be separated from testis

-Treatment:
Child: ligation of processus vaginalis via inguinal incision
Adult: jaboulay or lads operation via scrotal incision

Question 4

What are the differentials and treatment of Epididymal cyst (spermatocele)?

Answer 4

Differentials: Small and can be separated from testis

Treatment:
-Either left or excised
-No aspiration is done

Question 5

What are the differentials and treatment of hernia?

Answer 5

Differentials:
-Ingiunoscrotal
-Reducible
-Expansile impulse on cough

Treatment:
-Hernial repair (herniorrhaphy, hernioplasty)

Question 6

What are the differentials and treatment of testicular tumor?

Answer 6

Differentials:
-Scrotal
-Features of malignancy (witch loss, mets., ⬆️AFP and B-HCG)

Treatment:
-Orchidectomy via ingunial approach
-Biopsy is contraindicated in testicular tumors

Question 7

What are the differentials and treatment of testicular torsion?

Answer 7

Differentials:
-Swollen testis and elevated

Treatment: Urgent scrotal exploration+orchidopexy of both testis (without investigations)

Question 8

What are the differentials and treatment of Hematocele?

Answer 8

Differentials:
-Swelling other than testis
-Testis in its normal place

Treatment:
Urgent scrotal exploration + evacuation

Question 9

What are the differentials and treatment of testicular inflammation?

Answer 9

Differentials:
-Fever, dyslexia, discharge
-Exaggerated cremasteric reflex.

1- Epidedymo-orchitis (after urological procedure)
2- Orchitis (with viral and parotid infection)

Treatment:
Medical treatment

Question 10

What are the differentials and treatment of Varicocele?

Answer 10

Differentials:
-With RCC
-After long standing
-Left>Right
-Bag of worms in scrotum

Treatment:
-conservative management except of affects fertility—testicular veins ligation via inguinal approach

Question 11

The most common organism in epididymo-orchitis is…

Answer 11

Chlamydia

Question 12

Testicular torsion os often associated with lost cremasteric reflex but if there is exaggerated cremasteric reflex…

Answer 12

Torsion of the appendages/Hydatid/Morgagni cyst

Question 13

Morgagni cyst torsion is characterized by..

Answer 13

Blue dot sign present in the upper pole of the testis due to ischemia of the testicular appendages

Question 14

After vasectomy , a painful swelling in the scrotum May develop called…

Answer 14

Sperm granuloma

Question 15

…. is a para-testicular tumor of the distal part of the spermatic cord happening with bimodal age 4months -16years with liability of LN spread in 30-40% of patients

Answer 15

Rhabdomyosarcoma

Question 16

Leydig cell tumor of the testis is associated with…

Answer 16

Gynecomastia

Question 17

What is an undescended testis, it’s incidence and associations?

Answer 17

Testis failed to reach the scrotum by 3 months of age

Incidence: 5% on birth>1% by 3 months

Associations:
-Patent processus vaginalis
-Hypospedius
-Wilms tumor
-Gastroschisis

Question 18

What is the differential diagnosis of undescended testis?

Answer 18

Retractile testis, due to overactive cremasteric reflex

Question 19

Why must undescended testis be treated?

Answer 19

Increases the risk of developing testicular cancer mainly teratoma of the testis

Question 20

What is the treatment of undescended testis?

Answer 20

-Less than 2 years: orchidopexy at the age of 6-18months
-If more than 2 years: Orchiectomy
-If infra-abdominal or impalpable: laparoscopy

Question 21

What are the risk factors for testicular tumors?

Answer 21

-Undescended testis
-Family history
-AIDS
-Klinefelter syndrome

Question 22

What are the types of testicular cancers?

Answer 22

Germ cell tumors: 95%
-Seminoma (classic seminoma and spermatocytic seminoma)
-Non seminoma (teratoma, yolk sac tumor, choriocarcinoma, embryoal carcinoma)

Sex cord tumors: <5%
-Leydig cell tumor
-sertoli cell tumor

Question 23

Mention the following about classical seminoma and teratoma;
-Mean age
-Mass shape
-Pathological features
-Metastasis
-Aggressiveness
-Markers

Answer 23

Classical seminoma:

-Mean age: 30s
-Mass shape: homogenous regular mass
-Pathological features: sheets of uniform cells with lymphocytes
-Metastasis: Late metastasis
-Aggressiveness: less aggressive, more radiosensitive
-Markers: ⬆️LDH, ⬆️B-HCG in 10% only

Teratoma:

-Mean age: 20s
-Mass shape: hoterogenous irregular mass
-Pathological features: different types of tissues hair, teeth, bone.
-Metastasis: Early metastasis
-Aggressiveness: More aggressive
-Markers: ⬆️AFP, ⬆️B-HCG