Hx of scrotal lump
Time of onset
Regional lymph nodes
+ Tenderness, temprature and transilluminsation.
Make sure to see if you can separately palpate all structures in scrotum
1st line is USS of scrotum
Blood tests or further imaging miay be warrante
Abnormal collection of peritoneal fluid between parietal and visceral layers of the tunica vaginalis.
Clinilca features of hydrocoele
Painless fluctuatin swelling
Unilateral or bilateral
Can happen congenitally
Management of congenital hydrocoele
Usually regress spontanesouly by one or two years of age
No treatment is usually needed
If there is a patent processus vaginalis ligation will be required to stop recurrence
Causes of hydrocoele in older men
Secondary due to trauma, infetion or malignancy.
Between 20-40 with presentation should have urgent USS
What is varicocoele
Abnormal dilation of the pampiniform venous plexus within the spermatic cord.
Clinical features of varicocoele
Lump as a bag of worms or with a dragging sensation.
May disappear on lying flat
Examine lying down and standing up and perform a valsalva manoeuvre
Where are most varicocoeles found?
On the left side as it drains into left renal vein instead of IVC as done on the right
Complications of varicocoele
Can cause infertility and testicular atrophy by increasing intra-scrotal temperature
Semen analsysis and referral to urology should be done.
Red flag signs of varicocoele
Remain when lying flat
These should be investigated urgently.
Treatment of asymptomatic varicocoeles
No need for tx
Treatment of symptomatic varicocoele
Surgical by embolisation by interventional radiologist.
Open or laparoscopic approach for ligation of the spermatic veins.
Explain epididymal cysts
Benign fluid-filled sacs arising from the epididymis
Clinical features of epididymal cysts
They present as a smooth fluctuant nodule and found above and separate from the testis.
It will transilluminate and are often multiple.
When are epididymal cysts seen?
Common pathoogy seen in middle aged men.
Treatment of epididymal cysts
Usually doesnt give symptoms and no association of malignancy.
This means that they dont generally need treatment
If the yare very large and symptomatic surgery might be required, try to avoid this in younger men as infertility can ensue.
Examination of testis of inguinal hernia
You cannot get above an inguinal hernia within the scrotum.
It may disappear upon lying flat
Benign testicular lesions
Leydig cell tumours
Sertoli cell tumours
usually due to mumps.
Rest and analgesia and it should self-limit
Intra-testicular abscess can be the cause which would need drainage and occasionally orchidectomy
Way to distinguish between lumps