Scrotal/Testicular pathology Flashcards
(32 cards)
What is a hydrocoele?
Collection of fluid within the tunica vaginalis (within scrotum or along spermatic cord).
Usually benign unless secondary to underlying pathology
Which age group are hydrocoeles most common in?
Over70s(~5%)
Infants(6%termbirths)
Why do hydrocoeles occur in adults?
Usually excessive fluid production within tunica vaginalis
Uusally idiopathic but may be due to inflammation/infection/tumour or torsion
Why do hydrocoeles occur in infants?
Due to patent processus vaginalis - still communicates with peritoneal cavity
What are the signs and symptoms of hydrocoele?
Swelling
- Extra testicular - usually anterior and inferior to testicle
- Non-tender - unless pain due to primary cuase
- cystic on palpation - feels like bag of fluid
Transilluminates - unless pus/blood filled
What investigations are used for hydrocoele?
Only investigate if suspect pathology
- USS
- exploratory surgery
- Aspiration? may aid spread of malignant cells
How do you manage hydrocoeles in adults?
Conservative unless pathological or uncomfortable
uncomfortable => scrotal support
- therapeutic aspiration
- surgical excision of tunica vaginalis
How do you manage hydrocoeles in children?
Usually resolves spontaneously within one year
- surgical closure of tunica vaginalis if persists
What is an epididymal cyst?
Extratesticularfluidfilledbenigncysts
- usuallyinheadofepididymis
What is a spermatocoele?
Distendedtubulefromretetestisorepididymisformingspermfilledbenigncyst
What is the incidence of epididymal cyst and spermatocoele?
20-30 % of men >30y/o
rare in men < 30y/o
How does a epididymal cyst and spermatocoele present?
Extratesticularcysticswellings
Mayfluctuate,maybemultiple
Palpableasseparatemassfromtestis
What investigations for a epididymal cyst or a spermatocoele?
Transillumination(+exam)usuallysufficienttodiagnose
USS–Ifindoubt
Don’t aspirate (not useful)
How do you manage an epididymal cyst or spermatocoele?
Conservativeifasymptomatic
- Surgicalexcision
- Sclerotherapy=Medication
o e.g.tetracyclineinjectedtoshrinkcyst
What impact does epididymal cyst or spermatacoele have on fertility?
Neither cyst has impact on fertility
If coexisting infertility, treatment won’t improve
What is a varicocoele?
Abnormal dilatation of veins of pampiniform plexus - causes/associated with infertility
Aetiology of varicocoele
More common on left
- due to 90* angle and inadequate valves as left testicular vein enters left renal vein - increased back pressure
Pathophysiology of varicocoele?
Impairs sperm production due to increased temperature of testicle
May inhibit testicular growth due to decreased testosterone production
What is the presentation of a varicocoele?
Usuallyasymptomatic(painorheavinessin<10%)
Infertility
Visible/palpable‘bagofworms’
What investigations are needed for a varicocoele?
Examinationwhilststanding: increased pressure&dilatation
- Pressure may further increase by coughing or Valsalvamanoeuvre(blowingwithmouthshut&nosepinched)
USS&dopplervenography
Describe the management for a varicocoele?
Conservativeifasymptomatic(&noinfertilityproblems)
Surgicalrepair
Sclerotherapy
Embolisation
What is epididymitis and what is epididymo-orchitis?
The inflammation of the epidiymis
The inflammation of the epidiymis and testicle
Both usually due to infection
What is the aetiology behind epididymitis and epididymo-orchitis?
Usually ascending infection from urethra via retrograde passage of infected urine
- urethral obstruction and catheters increase risk
STIs may be a cause in the young
What organisms cause epididymitis and epididymo-orchitis?
STIs - Gonorrhea & chlamydia (< 35y/o)
Gram -ve: E.coli, Pseudomonas, Klebsielle
Staph/Strep (>35 y/o)
Viral: Mumps
Non-infective: trauma, autoimmune (Behcet’s), amiodarone (drug)
