Testicular Masses

Question 1

Outline the pathogenesis of a hydrocoele

Answer 1

• Normally the processus vaginalis is obliterated at the deep inguinal ring. Failure of this allows fluid communication and can allow herniation
• If fluid is produced by the tunica vaginalis more than it is absorbed, this can form a non-communicating hydrocoele

Question 2

What are the risk factors for forming a hydrocoele?

Answer 2

• Male sex
• Prematurity/infants
• Late testes descent
• Increased intraperitoneal pressure
• Scrotal inflammation/injury
• Testicular cancer

Question 3

What are the likely history/exam findings in someone with a hydrocoele?

Answer 3

• Risk factors
• Variation in mass during day
• Enlargement of mass following activity
• Transillumination

Question 4

What tests should be ordered in someone suspected of a hydrocoele?

Answer 4

• Diagnosis can generally be made clinically, but US scrotum can be helpful to exclude tumours with reactive hydrocoele

Question 5

What are the principles of management for someone with a hydrocoele?

Answer 5

• Observation
• Surgical ligation of opening if persistent/large/infected

Question 6

What is the difference on history/examination between a hydrocoele, and spermatocoele and a varicocoele.

Answer 6

• Hydrocoele
  
  • Transilluminates, non-separable, non-tender, varies in size during day
• Spermatocoele
  
  • Transilluminates, separable, non-tender, generally at head of epididymus
• Varicocoele
  
  • No transillumination, non-tender, feels like a bag of worms, increases with Valsalva, decreases when supine