Testicular and Scrotal Disorders Flashcards
What are the causes of painless scrotal swellings?
Transillumination +ve:
-Hydrocele and spermatocele
Transillumination -ve:
-Hernia and testicular tumor
What are the causes of painful scrotal swellings?
Post traumatic doesn’t improve with elevation of testis:
-Testicular torsion and hematocele
Not Post traumatic improves with elevation of testis:
-Inflammation and varicocele
What are the differentials and treatment of hydrocele?
-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
What are the differentials and treatment of Epididymal cyst (spermatocele)?
Differentials: Small and can be separated from testis
Treatment:
-Either left or excised
-No aspiration is done
What are the differentials and treatment of hernia?
Differentials:
-Ingiunoscrotal
-Reducible
-Expansile impulse on cough
Treatment:
-Hernial repair (herniorrhaphy, hernioplasty)
What are the differentials and treatment of testicular tumor?
Differentials:
-Scrotal
-Features of malignancy (witch loss, mets., ⬆️AFP and B-HCG)
Treatment:
-Orchidectomy via ingunial approach
-Biopsy is contraindicated in testicular tumors
What are the differentials and treatment of testicular torsion?
Differentials:
-Swollen testis and elevated
Treatment: Urgent scrotal exploration+orchidopexy of both testis (without investigations)
What are the differentials and treatment of Hematocele?
Differentials:
-Swelling other than testis
-Testis in its normal place
Treatment:
Urgent scrotal exploration + evacuation
What are the differentials and treatment of testicular inflammation?
Differentials:
-Fever, dyslexia, discharge
-Exaggerated cremasteric reflex.
1- Epidedymo-orchitis (after urological procedure)
2- Orchitis (with viral and parotid infection)
Treatment:
Medical treatment
What are the differentials and treatment of Varicocele?
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
The most common organism in epididymo-orchitis is…
Chlamydia
Testicular torsion os often associated with lost cremasteric reflex but if there is exaggerated cremasteric reflex…
Torsion of the appendages/Hydatid/Morgagni cyst
Morgagni cyst torsion is characterized by..
Blue dot sign present in the upper pole of the testis due to ischemia of the testicular appendages
After vasectomy , a painful swelling in the scrotum May develop called…
Sperm granuloma
…. 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
Rhabdomyosarcoma
Leydig cell tumor of the testis is associated with…
Gynecomastia
What is an undescended testis, it’s incidence and associations?
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
What is the differential diagnosis of undescended testis?
Retractile testis, due to overactive cremasteric reflex
Why must undescended testis be treated?
Increases the risk of developing testicular cancer mainly teratoma of the testis
What is the treatment of undescended testis?
-Less than 2 years: orchidopexy at the age of 6-18months
-If more than 2 years: Orchiectomy
-If infra-abdominal or impalpable: laparoscopy
What are the risk factors for testicular tumors?
-Undescended testis
-Family history
-AIDS
-Klinefelter syndrome
What are the types of testicular cancers?
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
Mention the following about classical seminoma and teratoma;
-Mean age
-Mass shape
-Pathological features
-Metastasis
-Aggressiveness
-Markers
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
