Urology: testicular presentations Flashcards
What are the complications associated with an undescended testes?
Increased chance of a testicular tumour being diagnosed late, as it is harder to feel a testicular lump when it is in the inguinal region
Define a varicocele
Abnormal enlargement of the testicular veins. Usually asymptomatic
What is a distinguishing feature of an epididymal cyst, on examination of the testis?
Palpated as separate from the body of the testicle
Name a condition that can predispose a patient to epididymal cysts
von Hippel-Lindau syndrome - where you get multiple tumours and cysts around the body.
polycystic kidney disease
cystic fibrosis
What is the likely diagnosis of a scrotal swelling that you can not get above (i.e has no superior border), feels separate to the testicle but does not transilluminate?
Inguinal hernia - a scrotal swelling you can’t get above!!!
Define a testicular lump
Scrotal lump - abnormal mass or swelling in scrotum
Where can testicular lump present?
In testis, or extra-testicular.
What should you ask about in Hx taking of testicular lump?
Pain??? Onset of Sx, previous Sx.
What are the 6 S’s involved in inspection of testicles?
Size, Shape, Site, Skin changes, Symmetry, Scars.
When palpating testis in scrotal exam, what are you checking for?
Tender, Transilluminates, Temperature. Consistency, Attachments, Pulsations, Fluctuations, Regional LN, Irreducibility, the Edge (3Ts (by the) CAMPFIRE)
How does hydrocele present?
Soft swollen large testicle, painless usually, unilateral usually. Pain on walking or sitting.
What may be present in PMH of pt presenting with hydrocele?
Trauma, testicualr torsion, testicualr cancer, epidimo-orchitis.
What are RF for hydrocele?
Premature babies, infection, STI, inflammation, trauma
What is the pathophysiology of a hydrocele?
Collection of fluid in the tunica vaginalis.
What investigations would you do in pt with suspected hydrocele?
Scrotal USS, Exclude cancers, Bloods - AFP (teratomas), B-HCG (teratoma and seminomas)
How is hydrocele managed?
Conservatively if idiopathic. If v large or symptomatic - surgery, aspiration, scleropathy.
What are Ddx for hydrocele?
Testicular cancer, hernia
Between what age group is a hydrocele a red flag?
Between 20-40.
How does varicocele present?
Bag of worms - visible enlarged veins. 90% on L side. Dull throbbing pain worse on standing. Ache at end of day. Swollen scrotal mass, may be hot to touch. Dragging sensation. Sub fertility.
What is pathophysiology of varicocele?
Abnormal dilatation of pampiniform venous plexus. This usually drains into testicular vein. Get either increased resistance or incompetent valves = get back flow at testicular vein.
More common on left side as:
left pampiniform plexus is subjected to increased hydrostatic pressures due to the right-angle insertion of the left internal spermatic vein into the left renal vein. Whereas, the right internal spermatic vein joins the inferior vena cava at an oblique angle.The left internal spermatic vein is also 8 to 10 cm longer, resulting in increased hydrostatic pressure transmission
Why is there reduced fertility with varicocele?
Increased heat = testicular atrophy and reduced fertility. Usually, testicuar vein removes heat from blood from artery - in varicocele, can not do this.
What are the 3 ways to examine pt with suspected varicocele?
- standing up = prominent. 2. lying down = disappears. 3. valsava manoeuvre - when feel scrotum, feel bag of worms.
How is varicocele diagnosis confirmed?
USS w/ Doppler imaging.
How is varicocele surgically managed?
Open or laproscopic surgery to ligate spermatic veins.
What red flags are associated to varicocele?
If does not reduce when lying down OR onset is acute OR is R sided = need urgent referral.
A L sided varicocele can be a sign of TCC obstructing L testicular vein
How does epididymal cyst present?
Soft, round, fluctuant lump. Lump SEPARATE to testicle. At top of testicle. Painless usually. Middle aged men.
What are RF for epididymal cyst?
CF, Polycystic kidney disease, von Hippel-Lindau syndrome
What is the pathophysiology of epididymal cysts?
Fluid filled cysts.
Investigation for epididymal cyst?
USS
How are epididymal cysts managed?
Rare to be symptomatic, small painless etc.
Often reassurance as no link to malignancy
Surgery only if v rare there was pain / symptoms but best to avoid as can lead to infertility in men
Large or painful cysts can be surgically removed or treated by aspiration and injection of a substance to shrink and seal the cyst.
What are Ddx for epididymal cyst
Lipoma, hydrocele, varicocele
Which organism most commonly causes acute epididymo-orchitis in men?
Chlamydia trachomatis
What is Prehn’s sign?
Testicular torsion- Elevation of testes does not ease the pain
Features of epidimo-orchitis?
Unilateral testicular pain and swelling
Dragging sensation in testicle
Swelling of testicle/ epididymis
Uretheral discharge (possible)
Not as acute or severe as testicular torsion
What are the complications associated with an undescended testes?
Increased chance of a testicular tumour being diagnosed late, as it is harder to feel a testicular lump when it is in the inguinal region
What is Fournier’s gangrene?
Necrotising fasciitis of the perineum - see erythema around sacrum and perineum, black skin in perineum
Why is Fournier’s gangrene a surgical emergency?
Can cause rapid uncontrollable necrosis of tissue, can lead for death by overwhelming sepsis if not treated promptly.
