Urology - Lumps In The Groin And Scrotum

Question 1

What is a differential for a lump in the groin and scrotum

Answer 1

• Can’t get above: inguinoscrotal hernia
• Separate and cystic: epididymis cyst (can transilluminate)
• Separate and solid: varicocele, sperm granuloma, epididymis
• Testicular and cystic: hydrocele
• Testicular and solid: tumour, orchid is and haematocele

Question 2

Give main points about epididymal cysts

Answer 2

• Develop in adulthood
• contain clear or milky fluid
• lie above and behind testis
• remove if symptomatic
• *Common in CF pts b/c no working vas

Question 3

Varicocele (definition and presentation)

Answer 3

• Definition: dilated veins of pampiniform plexus
• Presentation: feel like bag of worms in scrotum, may have visible dilated veins, pt may have dull ache, may have oligospermia (decreased fertility)

Question 4

Varicocele: pathology

Answer 4

• Left side is more common: drains into left renal vein

- Left renal tumour has tracked down renal vein —> testicular vein obstruction

Question 5

Varicocele: Mx

Answer 5

• Conservative: scrotal support

- Surgical: clipping of testicular vein (open or lap)

Question 6

Sperm granuloma: what is it?

Answer 6

-Painful lump of extravasated sperm after vasectomy

Question 7

Hydrocele: definition, primary and secondary

Answer 7

• Definition: collection of serous fluid within tunica vaginalis
• Primary: Associated with patent processus vaginalis, commoner in younger men.
• Secondary: tumour, trauma, infection (smaller and less tense)

Question 8

Hydrocele: Ix and Mx

Answer 8

• Ix: US testicle to exclude tumour
• Mx: may resolve spontaneously
• Surgery: Lord’s repair (plication of sac), Jaboulay’s repair (eversion of sac), aspiration (usually leads to recurrence so not 1st line + send fluid for cytology and MC+S)

Question 9

Haematocele: main points

Answer 9

• Blood in tunica vaginalis
• Hx of trauma
• May need draining or excision

Question 10

Epididymio-orchitis: aetiology

Answer 10

• STI: chlamydia and gonorrhea
• Ascending UTI: E. coli
• Mumps

Question 11

Epididymio-orchitis: features

Answer 11

• Sudden onset tender swelling
• Dysuria
• sweats, fever

Question 12

Epididymio-orchitis: examination findings

Answer 12

• Tender, red, warm, swollen testis and epididymis
• Elevating testicle may relieve pain
• Secondary hydrocele
• urethral discharge

Question 13

Epididymio-orchitis: Ix

Answer 13

• Bloods: FBC, CRP
• Urine: dip, MC+S
• Urethral swab and STI screen
• US: may be needed to exclude abscess

Question 14

Epididymio-orchitis: complications to be aware of

Answer 14

-May cause infertility

Question 15

Epididymio-orchitis: Mx

Answer 15

• Bed rest
• analgesia
• Scrotal support
• ABX: local guidelines
• Drain abscess if present