Non malignant scrotal disease Flashcards Preview

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Flashcards in Non malignant scrotal disease Deck (25):
1

Another name for epididymal cyst

spermatocele

2

What is an epididymal cyst

A retention cyst of a tubule of the rete testis or the head of the epididymis distended with barely watery fluid that contains spermatozoa

3

clinical features epididymal cyst

not painful
large ones can be uncomfortable

4

aetiology epididymal cyst

can originate as diverticulum from the tubules found in the head of the epididymis
sperm formation gradually causes the diverticulum to increase in size, causing a spermatocele
can also result from epididymitis or physical trauma

5

diagnosis epididymal cyst

physical exam
USS

6

rx epididymal cyst

small cysts left alone
large asymptomatic cysts left alone
spermatocelectomy may not improve symps

7

hydrocele

a pathological accumulation of serous fluid in a body cavity - in this case around a testicle
caused by fluid secreted by tunica vaginalis

8

aetiology hydrocele

- excessive production of fluid within the sacc
- defective absorption of fluid
- interference with lymphatic drainage
- connection with a hernia of the peritoneal cavity in the congenital variety, which presents as hydrocele of the cord

9

primary hydrocele

swelling is soft and non tender
large in size
testis cant be felt
can get huge but no pain - in LT can cause atrophy of testis

10

secondary hydrocele

cancer
trauma (eg hernia)
orchitis (inflammation of testis)
underlying testis is palpable

11

diagnosis hydrocele over tumour

attempting to shine a strong light through the enlarged scrotum
a hydrocele will usually pass light while a tumour will not

12

clinical diagnosis hydrocele

primary hydrocele has:
transillumination positive
fluctuation positive
impulse on coughing
testis cannot be palpated separately

13

rx hydrocele

most resolve without rx
surgical removal for persisting
if tumour suspected, hydrocele must NOT be aspirated as malignant cells can be disseminated via the scrotal skin to its lymphatic field - this is excluded by USS and it can then be aspirated

14

varicocele

abnormal enlargement of the pampiniform venous plexus in the scrotum
this plexus drains the testicle
defective valves or compression of the vein can cause dilatation of the testicular veins leading to the formation of a varicocele

15

serious result of varicocele if not treated

one of the main causes for infertility

16

signs and symptoms varicocele

visible or palpable enlarged vein
dragging like or aching pain in scrotum
feeling of heaviness in testicle
atrophy of testicles
alteration of testosterone levels
BPH and related urinary problems

17

what side do majority of varicoceles occur on

left side because left testicular vein travels superiorly and connects to the left renal vein (at 90 deg angle), while the right testicular vein drains directly into the IVC

18

cause secondary varicocele

compression of testicular drainage due to pelvic or abdo malignancy

19

diagnosis varicocele

non tender twisted mass along spermatic cord
testicle on side of varicocele may be smaller
reliably diagnosed with USS

20

rx varicocele

surgery
embolisation / blockage of pampiniform plexus

21

testicular torsion

occurs when the spermatic cord twists cutting off the testicles blood supply causing ischaemia

22

symptom testicular torsion

rapid onset of testicular pain

23

cause testicular torsion

congenital malformation - bell clapper deformity where testis is inadequately affixed to the scrotum allowing it to move freely on its axis

24

diagnosis testicular torsion

made on presenting signs and symptoms
urgent US if diagnosis unclear
irreversible ischaemia occurs after 6h of onset so emergency diagnosis and rx requires to minimise testicle loss

25

rx testicular torsion

surface of the testicle needs to be rotated toward the midline of the body
non surgical correction can sometimes be accomplished by manually rotating the testicle in the opposite direction
If not - it is a surgical emergency