Urology - scrotal lumps Flashcards
Differential for testicular lumps
Hydrocele Varicocele Epididymal cyst Testicular cancer Epididymo-orchitis Inguinal hernia Testicular torsion
What is a hydrocoele?
A hydrocele is a collection of fluid within the tunica vaginalis that surrounds the testes
Usually painless
What are the examination findings in hydrocoele?
Usually painless
Palpable testicle within hydrocoele
Soft, fluctuant
Transilluminates with torch
Irreducible and no bowel sounds (distinguishing it from a hernia)
What can cause hydrocoele?
Can be idiopathic
Or secondary to:
- Testicular cancer
- Testicular torsion
- E-O
- Trauma
Management of hydrocoele?
Exclude serious causes e.g. cancer, torsion
May be managed conservatively if idiopathic
Surgery, aspiration or sclerotherapy may be needed in large or symptomatic cases
What occurs to cause varicocoele?
Veins in pampiniform plexus become swollen
Presentation of varicocoele
Usually occur on the left (90% - due to increased resistance in the left testicular vein which drains into the left renal vein rather than the IVC (right testicular vein drainage))
Throbbing/dull pain worse on standing
Dragging sensation
Sub or infertility
What can right sided varicocoele indicate?
Renal cell carcinoma due to compression of the right testicular vein
Red flags in varicocele?
Acute onset
Right-sided
Remain when lying flat
If any of these - should be investigated urgently
What are the examination findings in varicocoele?
A scrotal mass that feels like a “bag of worms”
More prominent on standing
Disappears when lying down
Asymmetry in testicular size if the varicocele has affected the growth of the testicle
If varicocoeles don’t disappear on lying down …
Be concerned about retroperitoneal tumours obstructing renal vein drainage
Urgent referral to urology for further investigation:
- Ultrasound with doppler
- Semen analysis if fertility concerns
- Hormonal tests e.g. FSH, testosterone if concerns about function
Management of varicocoele if simple
Uncomplicated e.g. asymptomatic cases may not need treatment
Surgical management e.g. Embolisation
- May be indicated for pain, testicular atrophy or infertility
Epididymal cyst presentation - history and examination
Most are asymptomatic
Patients may have felt a lump
Examination:
- Soft, round lump
- Typically at the top of the testicle
- Associated with the epididymis
- Separate from the testicle
- May be able to transilluminate large cysts
Very rarely there may be torsion of the cyst causing acute pain and swelling
What is the management of epididymal cysts?
They are usually harmless and not associated with infertility/cancer
So usually not treated
If large or painful - may consider removal
