testicular lumps

Question 1

What is a hydrocele?

Answer 1

accumulation of fluid within the tunica vaginalis

Question 2

features of a hydrocele

Answer 2

1. attatched to testes / not seperate
2. transilluminate
3. possible to feel above the lump

Question 3

Mx of a hydrocele

Answer 3

1. first line - surgery

2. second line - aspiration

Question 4

what is a varicocele?

Answer 4

1. dilatation of veins in the pampiniform plexus within the spermatic chord
2. 95% on the left hand side as there is increased venous pressure when left testicular vein –> left renal vein

Question 5

what are the features of a varicocele?

Answer 5

1. feels like ‘bag of worms’
2. disappears lying down
3. comp - may cause subfertility

Question 6

Mx of varicocele

Answer 6

conservative reassurance

if complications consider surgery

Question 7

what is an epididymal cyst?

Answer 7

transilluminable swellings felt in the scrotum behind the testes

Question 8

How does a hernia present in the groin?

Answer 8

1. indirect inguinal hernia can present has a swelling in the groin
2. cough impulse
3. not possible to feel above it

Question 9

what is Epididymitis?

Answer 9

1. infection of the epididymis leading to scrotal
2. caused by chlamydial infection in young men
3. may be caused by ascending urehtra and bladder infection

Question 10

How does epididymitis present?

Answer 10

1. scrotal discomfort
2. pain during micturition
3. fever
4. features of underlying sti/uti

Question 11

mx of the epididymitis?

Answer 11

1. if STI - 2 week course of doxycyline

2. analgesia

Question 12

How does testicular torsion present?

Answer 12

1. sudden onset severe testicular pain
2. abdominal pain
3. vomitting

Question 13

Mx of testicular torsion

Answer 13

urgent surgical intervention and urgent orchidopexy - testes sutured into the tunica vaginalis to prevent further torsion

Question 14

Name 3 differential diagnosis of a painful testicular lump?

Answer 14

1. torsion
2. epididymitis
3. strangulated hernia

Question 15

What are the signs seen in testicular torsion?

Answer 15

1. swollen and tender
2. high riding
3. cremasteric reflex absent
4. Phren’s sign is negative

Question 16

what is ‘phren’s sign’?

Answer 16

1. helps differnetiate testicular torsion vs epididymitis

2. physical lifting of the testes relieves the pain of epididymitis but not the pain of testicular torsion

Question 17

Ix of testicular torsion

Answer 17

1. bloods - inc inflammatory markers
2. urine dipstick and MSSU
3. Doppler ultrasound scan to confirm diagnosis

Question 18

Ix of epididymitis?

Answer 18

1. Bloods - inflammaotry markers
2. MSSU
3. urethral swabs / urine chlamydia
4. US of scrotum

Question 19

differentiating torsion vs infection

Answer 19

Torsion

1. more acute and sudden pain
2. • urine dipstick
3. no infective symptoms
4. lifting does not ease

Infection

1. gradual onset
2. more infective symptoms (fever)
3. positive urine dipstick
4. lifting may ease