Session 1: Case Studies Flashcards
List some common causes of scrotal swelling.
Testicular torsion
Torsion of the testicular or epididymal appendage
Lymphadenopathy
Strangulated inguinal hernia
Varicocoele Haematocoele Spermatocoele Hydrocoele Epididymal cyst
Why does a lump in the testis of a 22 year old need follow up?
Could be testicular torsion leading to infertility
Could be prostate cancer
Could be a varicocoele
In very general terms, How might you discriminate between a hernia and a swelling associated with the testis?
Hernias and varicocoele are more prominent on standing up than sitting down.
Which veins are dilated in a varicocoele?
What does it feel like upon palpation?
Usually in pampiniform venous complex of the left testicular artery.
Upon palpation you might feel small soft lumps usually superior to the testis (usually on the left). It might feel like a bag of worms as well.
Predict why are varicocoele is more common on the left?
Because the venous drainage is long and more complex on the left side.
Right testis drain from PFP directly to right testicular vein and then IVC.
Left drain from PFP to left testicular vein then to left renal vein and then IVC.
This means that there is higher venous resistance and can also be caused by renal cancer.
What is a hydrocoele?
Accumulation of fluid in the tunica vaginalis (the cavity of it).
Explain why hydrocoeles in young boys often get bigger when they cough or cry.
Increase in pressure of abdominal cavity which is somewhat continuous.
How would you diagnose a hydrocoele via examination?
Trans-illuminate.
Explain why trans-illumination with a small bright torch can distinguish between a hydrocoele (or cystic mass) and a solid mass such as a tumour.
A hydrocoele or cystic mass is filled with fluid and transillumination would work in that case.
A solid mass will only have some or won’t have any light shining through.
What is the cremasteric reflex?
Stroking the skin of the medial side of the thigh evokes a reflex contraction of cremaster which will elevate the ipsilateral testis.
This reflex is due to the genitofemoral nerve (L1 and L2 nerve roots). However the afferent arc of the reflex may be via sensory fibres in the ilioinguinal nerve.
You might also get this cremasteric reflex when it’s cold outside.
What is the clinical significance of the absence of the cremasteric reflex?
It might be absent in testicular torsion.
What is testicular torsion?
How is this related to the way in which the testis is suspended in the scrotum?
When the spermatic cord twists on its axis.
If the posterior lateral aspect of the tunica vaginalis is not attached to the testis. This means that the testis can start twisting on their own. This makes it more common in that condition.
Contents of the spermatic cord.
3 layers of fascia (internal spermatic, cremastic fascia, external spermatic) 3 arteries (testicular artery, artery to vas def, artery to cremastic muscle) 3 veins (testicular vein, vein to vas def, vein to cremastic) 3 nerves (nerve to vas def, genital branch of genitofemoral nerve, ilioinguinal nerve (technically outside)) Lymph Vas def
Testicular torsion is a urological emergency.
Explain with reference to the pathophysiology, why urgent management is required.
Because it can cause ischaemia and cause necrosis of the testis. If the testis starts die, it should be removed. This is because the dying testis can release antibodies which will attack the other testis and make it die as well rendering the patient infertile.
This is also common in the necrosis of an eye where you need to remove the eye in order to prevent sympathetic opthalmia.
What part of the prostate gland is felt on a Digital rectal examination?
The posterior part aka the peripheral zone.
