Groin/scrotal lumps Flashcards
(23 cards)
DD of swellings?
Cant get above? Hernia
Separate, cyst: epidydimal cyst
Separate, solid: varicocele, sperm granuloma, epididimitis
Testicular, cystic: hydrocele
Testicular, solid: tumour, orchitis, haematocele
What are epidydimal cysts?
Develop in adulthood, contain clear or milky (spermatocele) fluid
Lie above and behind testis
remove if symptomatic
What is a varicocele and what does it feel like?
Dilated veins of pampiniform plexus
bag of worms in the scrotum, may be visible dilated veins, decreases in size if lying down and patient may complain of dull ache
Pathology of Varicocele?
Left side commoner in primart as drains into left renal vein
secondary= tumour tracked down left renal vein
Management of varicocele?
Conservative: scrotal support
Surgical: clip the vein
Complications of varicocele?
can cause subfertility, though repair doesnt seem to improve rates of pregnancy
What is a sperm granuloma?
Painful lump of extravasated sperm after vasectomy
What is a hydrocele?
Collection of fluid in the tunica vaginalis
Primary v secondary hydrocele?
Primary is associated with a patent process vaginalis, commoner larger, young
Secondary is due to trauma, tumour, infection
smaller and less tense
Ix in hydrocele?
US to exclude a tumour
Mx of Hydrocele?
May resolve spontaneously
Surgery: lords- plication of sac
Jabouleay- eversion of sac
Aspiration: usually recur so not first line, send fluid for cytology, mc and s
What is a haematocele?
Blood in tunica vaginalis, hx of trauma and may need drainage/incision
Aeitiology of epididymo-orchitis?
STI: chlamydia, gonnorhea
ascending UTi: Ecoli
Mumphs
Features of epididymo-orchitis?
Sudden onset tender swelling, dysuria, fever
Tender warm and swollen testis, elevating testicle may reduce pain
Secondary hydrocele
discharge
Ix in epididymo-orchitis?
Blood: fbc/crp
urine dip
urethral swab and UTI screen
US may be needed to exclude abscess
Complications of epididymo-orchitis?
May decrease fertility
Mx of epididymo-orchitis?
Bed rest, analgesia, scrotal support
abx according to infection
drain any abscess
Aeitiology of testicular torsion?
usually secondary to minor trauma
occus as testicle doesnt have good area to attach to scrotal wall
Presentation of testicular torsion?
10-25yrs sudden onset severe pain lower abdominal pain n/v hx of previous torsion
Examination of torsion?
Inflammation of one testis, hot, swollen and ext. tender
Rides high and lies transversely
loss of cremasteric reflex
DD of testicular torsion?
Epidydimoorchitis: slower and older
Torted hydratid of morgagni
remnant of mullerian duct. younger, less painful and tiny blue dot
tumour
trauma
appendicitis
Ix in testicular torsion?
US may show absence of flow but DO NOT DELAY surgical exploration
Mx of testicular torsion?
SURGICAL EMERGENCY
4-6hr window to salvage testis
inform senior, NBM
Iv access: analgesia and take bloods
Surgery: consent for possible orchidectomy, bilateral orchidoplexy- surture testes to scrotum
If no torsion and EDO a DD then take fluid sample for bacteriology
