Non-cancer Scrotal diseases

Question 1

Any scrotal mass should be treated as ____ until proven otherwise

Answer 1

cancer

Question 2

Where is an epidydimal cyst located?

Answer 2

Extra testicular cyst, above and behind testis

Question 3

True or false: an epidydimal cyst will transilluminate?

Answer 3

True

Question 4

How do you diagnose an epidydimal cyst?

Answer 4

USS of scrotum

Question 5

What is an epidydimal cyst containing sperm called?

Answer 5

Spermatocele (managed same as epidydimal cyst)

Question 6

A hydrocele is a fluid collection in the…

Answer 6

tunica vaginalis

(originally part of peritoneal membrane, during development of fetus separates and remains in scrotum, partially covering each testicle.)

Question 7

True or false: a hydrocele will transilluminate

Answer 7

True

Question 8

What is a communicating hydrocele?

Answer 8

Tunica vaginalis is connected to the peritoneal cavity via the processus vaginalis allowing fluid to travel from the peritoneal cavity into the hydrocele.

Hydrocele may fluctuate in size.

Question 9

How do you diagnose a hydrocele?

Answer 9

USS of scrotum

Question 10

What can hydroceles be secondary to?

Answer 10

(can be idiopathic)
Testicular cancer
Testicular torsion
Epididymo-orchitis
Trauma

Question 11

How are hydroceles managed?

Answer 11

In new-borns will often recede as liquid is reabsorbed over time.

Can have surgery, aspiration or sclerotherapy in large of symptomatic cases.

Question 12

Where does the pampiniform plexus drain into?

Answer 12

Testicular vein

Question 13

What is a varicocele?

Answer 13

Distended pampiniform plexus veins due to increased resistance in testicular vein and incompetent valves allowing blood to flow back into the pampiniform plexus.

(mass of varicose veins in spermatic cord)

Question 14

What does the right testicular vein drain into?

Answer 14

The inferior vena cava

Question 15

What does the left testicular vein drain into?

Answer 15

The left renal vein

Question 16

What side is a varicocele mostly found?

Answer 16

Left

Question 17

What can a left-sided varicocele indicate?

Answer 17

Obstruction of left testicular vein caused be a renal cell carcinoma

Question 18

What is a varicocele often described as?

Answer 18

Bag of worms

Question 19

Is a varicocele painful?

Answer 19

Rarely when larger and more severe but typically they’re painless.

Question 20

What is a complication of varicocele?

Answer 20

Infertility
Probably to do with disrupting temperature of affected testicle.

Question 21

How do you diagnose a varicocele?

Answer 21

Physical examination
Doppler USS can provide details image of veins in scrotum.

Question 22

Should a varicocele disappear when lying down?

Answer 22

Yes, if not raises alarms of possible retroperitoneal tumours obstructing the drainage of the renal vein.

Question 23

What is testicular distorsion?

Answer 23

Spermatic cord twists on itself, occluding the testicular artery causing ischaemia.

Question 24

If testicular distortion is treated, what happens

Answer 24

Gangrene of testis

Question 25

What is a risk factor for testicular torsion?

Answer 25

Bell clapper deformity ("horizontal lie" of testes)

Question 26

How would a patient with testicular torsion present?

Answer 26

Severe uni-testicular pain (hurts to walk) Abdominal pain N&V No pain relief with elevating testis Cremasteric reflex lost.

Question 27

What is the cremasteric reflex?

Answer 27

Stroke inner thigh, ipsilateral testicle should elevate/retract upwards

Question 28

How do you diagnose testicular torsion?

Answer 28

1st line = Surgical exploration - emergency USS to check testicular blood flow

Question 29

How do you treat testicular torsion?

Answer 29

urgent surgery within 6 hours (90-100% success rate)

Question 30

What is Prehn's sign and when is it used?

Answer 30

Lifting half of the scrotum to assess consequent change in pain used to determine cause. Positive = relief of pain Negative = exacerbation of pain

Question 31

What does a positive Prehn's sign indicate

Answer 31

Relief of pain suggests acute or chronic epididymitis (bacterial infection often from STIs)

Question 32

What does a negative Prehn's sign indicate?

Answer 32

Exacerbation of pain suggests testicular torsion as spermatic cord compressed