Scrotum Pathology

Question 1

What are epididymal cysts?

Answer 1

The most common cause of scrotal swellings seen in primary care

Question 2

Where are epididymal cysts typically found?

Answer 2

Posterior to the testicle and separate from the body of the testicle

Question 3

List three associated conditions with epididymal cysts.

Answer 3

• Polycystic kidney disease
• Cystic fibrosis
• Von Hippel-Lindau syndrome

Question 4

How can the diagnosis of epididymal cysts be confirmed?

Answer 4

By ultrasound

Question 5

What does epididymo-orchitis describe?

Answer 5

An infection of the epididymis +/- testes resulting in pain and swelling

Question 6

What are the common causes of epididymo-orchitis in younger adults?

Answer 6

Local spread of infections from the genital tract, such as Chlamydia trachomatis and Neisseria gonorrhoeae

Question 7

What are the common causes of epididymo-orchitis in older adults?

Answer 7

Infections from the bladder, such as E. coli

Question 8

What are the features of epididymo-orchitis?

Answer 8

• Unilateral testicular pain and swelling
• Urethral discharge may be present, but urethritis is often asymptomatic

Question 9

What factors suggest testicular torsion?

Answer 9

• Patients < 20 years
• Severe pain
• Acute onset

Question 10

What is the most important differential diagnosis for epididymo-orchitis?

Answer 10

Testicular torsion

Question 11

What investigations are guided by the patient’s age in suspected epididymo-orchitis?

Answer 11

• In younger adults: assess for sexually transmitted infections (STI)
• In older adults with a low-risk sexual history: send a mid-stream urine (MSU) for microscopy and culture

Question 12

What is the management if an STI is the most likely cause of epididymo-orchitis?

Answer 12

Advise urgent referral to a local specialist sexual health clinic

Question 13

What antibiotics does BASHH recommend if the organism is unknown?

Answer 13

• Ceftriaxone 500mg intramuscularly (single dose)
• Doxycycline 100mg by mouth twice daily for 10-14 days

Question 14

What should be done if enteric organisms are suspected in epididymo-orchitis?

Answer 14

• Send an MSU
• Treat empirically with an oral quinolone for 2 weeks (e.g., ofloxacin)

Question 15

What may be recommended following treatment of epididymo-orchitis?

Answer 15

Further investigations to exclude any underlying structural abnormalities