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Popular SAQ topics > Hydrocoele, Varicoele, Testicular Cancer and torsion > Flashcards

Hydrocoele, Varicoele, Testicular Cancer and torsion Flashcards

1
Q

Define hydrocoele

A

Describes collection of fluid in tunica vaginalis that surrounds the testes

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2
Q

What membrane is the tunica vaginalis part of?

A

Peritoneal membrane

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3
Q

Name and describe 2 subtypes of hydrocoele

A

Simple - Common in newborns. Fluid trapped in tunica vaginalis. Fluid usually reabsorbed over time and hydrocoele disappears

Communicating - tunica vaginalis is connected to peritoneal cavity via processus vaginalis. This allows fluid to trave from peritoneal cavity to hydrocoele, allowing it to fluctuate in size

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4
Q

Give 4 clinical features of hydrocoele

A

Soft, non-tender swelling around one testicle

Can be in-front or below testicle

Size can fluctuate (depends if simple or communicating)

Transilluminates with light (key feature)

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5
Q

Give 3 causes of hydrocoele

A

Primary hydrocoele - Idiopathic

Secondary hydrocoele - Infection (orchiditis, epididymitis)

Congenital hydrocele

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6
Q

What embryological structure does the tunica vaginalis arise from?

A

Processus vaginalis

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7
Q

Give 4 differentials for scrotal swelling

A

Hydrocoele

Inguinal hernia

Testicular Torsion

Partially descended testes

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8
Q

How is hydrocoele diagnosis confirmed?

A

Ultrasound

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9
Q

How are simple hydrocoeles managed?

A

Usually resolve in 2 years - Give reassurance and follow up

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10
Q

How are communicating hydrocoeles managed?

A

Surgery to remove/ligate connection between peritoneal cavity and hydrocoele (processus vaginalis)

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11
Q

Define varicocoele

A

Describes where veins of the pampiniform plexus become swollen

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12
Q

Give 2 complications of varicocoele

A

Impaired fertility (likely due to disrupting temperature in affected testicle)

Testicular atrophy

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13
Q

Where does the pampiniform plexus drain?

A

Testicular vein

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14
Q

Pathophysiologically, how do varicocoele’s form?

A

Occur due to increased resistance in the testicular vein,

Incompetent valves in testicular vein allow backflow of blood back into pampiniform plexus.

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15
Q

Where does the right testicular vein drain into?

A

Inferior vena cava

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16
Q

Where does the left testicular vein drain into?

A

Left renal vein

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17
Q

Where do varicocoeles most commonly arise?

A

Left side due to increased resistance of left testicular vein

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18
Q

What could a left sided varicocoele indicate?

A

Obstruction of the left testicular vein caused by renal cell carcinoma

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19
Q

Give 3 clinical features of varicoele

A

Throbbing/dull discomfort, worse on standing

A dragging sensation

Sub-fertility/infertility

20
Q

Give 4 examination findings for varicoele

A

Scrotal mass feels like a “Bag of worms”

More prominent on standing

Disappears when lying down

Asymmetry in testicular size

21
Q

If a varicoele doesn’t disappear when lying down, what may this indicate?

A

Retroperitoneal tumour obstructing drainage of renal vein.

Warrants urgent referral to urology

22
Q

Name 3 investigations important to conduct when investigating varicoele

A

Ultrasound with Doppler imaging (confirms diagnosis)

Semen analysis (if concerns about fertility)

Hormonal tests (FSH/LH if concerns about function)

23
Q

How are varicocoeles managed?

A

Uncomplicated - Conservative management

Pain, testicular atrophy or infertility - Surgery or endovascular embolization

24
Q

Define testicular torsion

A

Describes twisting of the spermatic cord with rotation of the testicle, resulting in ischaemia and necrosis.

Is a urological emergency

25
Q

Give 3 symptoms of testicular torsion

A

Acute onset severe unilateral testicular pain

Lower abdominal pain and vomiting

Triggered by activity (i.e playing sports)

26
Q

Give 5 examination findings for testicular torsion

A

Firm swollen testicle

Elevated/retracted testicle

Absent cremasteric reflex

Abnormal testicular lie (horizontal)

Rotation (epididymis is not in normal posterior position)

27
Q

Name 2 causes of testicular torsion

A

Activity (sport)

Bell-Clapper Deformity (fixation between the testicle and tunica vaginalis is absent)

28
Q

What deformity is associated with testicular torsion?

A

Bell-clapper deformity

29
Q

Describe how the Bell-Clapper Deformity causes testicular torsion (3)

A

Describes where fixation between testicle and tunica vaginalis is absent.

testicle hangs in horizontal position instead of typical vertical position.

This makes it able to rotate within the tunica vaginalis, twisting the spermatic cord.

30
Q

How is testicular torsion diagnosed? What will this show?

A

Scrotal Ultrasound

Shows whirlpool sign (spiral appearance of spermatic cord and blood vessels)

31
Q

Give 2 surgical options to treat testicular torsion

A

Surgical exploration;

Orchidoplexy (correcting position of testicles and fixing them in place.

Orchidectomy (removing testicle - if surgery is delayed or there is necrosis)

32
Q

How may testicular cancer present?

A

Painless hard nodule on one testicle

33
Q

What type of cancer are 95% of testicular cancers?

A

Germ cell tumours

34
Q

Name 2 types of germ cell tumours

A

Seminomas

Non-seminomas (embryonal, yolk sac, teratoma and choriocarcinoma)

35
Q

Give 4 risk factors for testicular cancer

A

Undescended testicles

Male infertility

Positive family history

Increased height

36
Q

Give 4 clinical features of testicular cancer

A

Painless, non-tender lump

Hard lump

Irregular

No transillumination

37
Q

What type of testicular cancer can present with gynaechomastia?

A

Leydig cell tumour (non-germ cell)

38
Q

What investigation confirms diagnosis of testicular cancer?

A

Scrotal ultrasound

39
Q

What imaging tool is used to stage testicular cancer?

A

Staging CT Scan

40
Q

Give 3 biochemical tumour markers for testicular cancer

A

Alpha fetoprotein - May be raised in teratomas

Beta hCG - May be raised in teratomas/seminomas

Lactate dehydrogenase (LDH) - Non-specific

41
Q

What system is used to stage testicular cancer?

A

Royal Marsden Staging System

42
Q

Describe the Royal Marsden Staging System for staging Testicular Cancer

A

Stage 1 - Isolated to testicle
Stage 2 - Spread to the retroperitoneal lymph nodes
Stage 3 - Spread to the lymph nodes above the diaphragm
Stage 4 - Metastasized to other organs

43
Q

Name 4 common places for testicular cancer to metastasize

A

Lymphatics

Lungs

Liver

brain

44
Q

How is testicular cancer managed? (5)

A

MDT meeting

Surgery - Radical orchidectomy

Chemotherapy/radiotherapy

Sperm banking

Follow up - Monitor tumour markers, CT or CXR

45
Q

Give 4 complications of the treatment for testicular cancer

A

Infertility

Hypogonadism (testosterone replacement may be required)

Peripheral neuropathy

Hearing loss

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