scrotal swelling Flashcards
(33 cards)
what are the layers of the scrotum
SD
skin
dartos muscle
ECI
external spermatic fascia
cremasteric muscle
internal spermatic fascia
parietal layer of tunica vaginalis
visceral layer of tunica vaginalis
tunica albuginea
what is hydrocele
serous fluid in tunica vaginalis layer btwn visceral and parietal
how can u difffer btwn hydrocele and hernia extended in scrotum
hydrocele by palpation feels soft non tender and you can go above swelling in hernia u cannot
what are causes of hydrocele
It can be congenital (present at birth) or acquired (develop later in life).
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- Congenital Hydrocele (Newborns & Infants)
Occurs due to incomplete closure of the processus vaginalis, allowing peritoneal fluid to enter the scrotum.
• Communicating hydrocele – Continuous connection with the abdomen, causing fluctuation in size
• Non-communicating hydrocele – Trapped fluid with no connection to the abdomen
- Acquired Hydrocele (Adults & Older Children)
Develops due to imbalance between fluid production and absorption in the scrotum.
Common Causes:
• Trauma or injury – Scrotal trauma, post-surgical complications (e.g., after hernia repair)
• Infection
how to diagnose hydrocele
trans-illumination like a scope with light shows if its blood pus or clear fluid
Transillumination positive (light passes through fluid-filled sac)
symptoms and RF of hydrocele
Painless swelling of one or both testicles, discomfort or heaviness
• Risk Factors: Injury or inflammation to scrotum, infections including STDs
tx of hydrocele
hyrocelectomy -
surgical excision of outer wall fluid draniage
excision of excess tunica vaginalis
spermatocele
benign sperm filled epidiymal retention cyst
also called a spermatic cyst, is a fluid-filled sac that develops in the epididymis (the small coiled tube behind the testicle that stores and transports sperm). The fluid inside the spermatocele contains sperm and other substances.
causes of spermatocele
unknown , blockage in epidydmal tube transpoting and storing sperm from testicle
RF of spermatocele
mothers who took DES during pregnancy (Diethylstilbestrol)
varicocele
Dilatation and tortuosity of pampiniform plexus secondary to incompetent valves in the veins (basically varicose veins in pampiniform )
symptoms of varicocele
• Dragging discomfort worse on standing
• Can cause primary infertility or subfertility
• Painless and pulsates with Valsalva or cough
varicocele mostly on left side why
Venous Drainage Pathways:
• Left Testicular Vein: This vein drains into the left renal vein at a right angle before emptying into the inferior vena cava. This longer and less direct pathway can lead to increased venous pressure, making varicoceles more likely on the left side. 
• Right Testicular Vein: In contrast, the right testicular vein drains directly into the inferior vena cava, providing a more straightforward route with potentially lower venous pressure.
also main anatomical reason why left renal vein more chance of suppression
Nutcracker Effect:
• The left renal vein can be compressed between the abdominal aorta and the superior mesenteric artery—a phenomenon known as the “nutcracker effect.” This compression increases pressure in the left testicular vein, further contributing to the higher incidence of left-sided varicoceles.
If only on the right varicocele or right>left you must rule out
retroperitoneal or renal pathology (i.e.
IVC obstructed)
grades of varicocele
o 1: palpable only with Valsalva (cough )
o 2: nonvisible on inspection, palpable on standing
o 3: visible on gross inspection
diagnosis of varicocele
U/S Doppler of scrotum and groin
tx of varicocele
we only treat it if severe pain or affecting fertility
o Venous embolization or retroperitoneal ligation of testicular vein
o Subinguinal ligation at level of superficial inguinal ring
o Varicocelectomy (complications: hydrocele and recurrent varicocele)
• If varicocele has acute onset, is only right-sided, or persists in supine position, then what must ve excluded in order to give chance to look for other diagnoses
IVC obstruction
testicular torsion in physical exam
1) cremasteric reflex
2) transverse line of torsion / testes
3) rotate of epidedymis anteriorly in torsion
4) -ve phren sign( when you pick it up it still would hurt but in orchitis would feel better)
5) red and tender
arterial supply to testes
testicular artery
artery to vas deferens
cremasteric A
testicular torsion caused by
bell clapper deformity
• Normal Attachment: The testicles are secured to the scrotal wall by the gubernaculum, epididymis, and surrounding tissues, restricting excessive movement.
• In Bell Clapper Deformity: There’s a failure in the normal posterior anchoring of these structures. Consequently, the testis can move and rotate within the tunica vaginalis, the protective covering of the testicle. This increased mobility heightens the risk of the spermatic cord twisting, leading to torsion.
intravaginal torsion
• Mechanism: Occurs when the testicle rotates within the tunica vaginalis, the protective sac surrounding it. This rotation twists the spermatic cord, compromising blood flow.
Often associated with the “bell-clapper deformity,” where the tunica vaginalis attaches abnormally high on the spermatic cord, allowing excessive mobility of the testicle within the scrotum. This increased mobility heightens the risk of torsion.
extravaginal torsion
• Mechanism: In this type, the entire testicle, along with its surrounding structures—including the tunica vaginalis and spermatic cord—twists as a single unit.
In newborns, the testicles have not yet firmly attached to the scrotal wall. This lack of fixation allows the entire testicular unit to rotate, leading to torsion. 
