urology - scrotal swellings Flashcards
(19 cards)
what is the most common cause of scrotal swellings in primary care?
Epididymal cysts
describe the features of an epididymal cyst
Features
separate from the body of the testicle
found posterior to the testicle
what conditions are associated with Epididymal cysts
Associated conditions
polycystic kidney disease
cystic fibrosis
von Hippel-Lindau syndrome
how do you diagnose an epididymal cyst?
USS
describe the clinical features of a Hydrocele
Features
soft, non-tender swelling of the hemi-scrotum. Usually anterior to and below the testicle
the swelling is confined to the scrotum, you can get ‘above’ the mass on examination
transilluminates with a pen torch
the testis may be difficult to palpate if the hydrocele is large
describe what a hydrocele is
Hydroceles may develop secondary to:
epididymo-orchitis
testicular torsion
testicular tumours
what is a varicocele and where does it exist?
Varicocele
A varicocele is an abnormal enlargement of the testicular veins. They are usually asymptomatic but may be important as they are associated with infertility.
Varicoceles are much more common on the left side (> 80%). Features:
classically described as a ‘bag of worms’
subfertility
how do you diagnose and Ix a varicocele?
Diagnosis ultrasound with Doppler studies Ix: - sperm counts- ASSOCIATED WITH INFERTILITY -
how do you manage varicoceles?
Management
usually conservative
occasionally surgery is required if the patient is troubled by pain. There is ongoing debate regarding the effectiveness of surgery to treat infertility
how do you manage varicoceles?
Management
usually conservative
occasionally surgery is required if the patient is troubled by pain. There is ongoing debate regarding the effectiveness of surgery to treat infertility
desribe an inguinal hernia
If inguinoscrotal swelling; cannot ‘get above it’ on examination
Cough impulse may be present
May be reducible
describe a testicular tumour
Often discrete testicular nodule (may have associated hydrocele)
Symptoms of metastatic disease may be present
USS scrotum and serum AFP and β HCG required
acute epididymorchitis - describe
Often history of dysuria and urethral discharge
Swelling may be tender and eased by elevating testis
Most cases due to Chlamydia
Infections with other gram negative organisms may be associated with underlying structural abnormality
describe an epididymal cyst
Single or multiple cysts
May contain clear or opalescent fluid (spermatoceles)
Usually occur over 40 years of age
Painless
Lie above and behind testis
It is usually possible to ‘get above the lump’ on examination
describe a hydrocele
Non painful, soft fluctuant swelling
Often possible to ‘get above it’ on examination
Usually contain clear fluid
Will often transilluminate
May be presenting feature of testicular cancer in young men
describe Testicular torsion
Severe, sudden onset testicular pain
Risk factors include abnormal testicular lie
Typically affects adolescents and young males
On examination testis is tender and pain not eased by elevation
Urgent surgery is indicated, the contra lateral testis should also be fixed
describe a Varicocele
Varicosities of the pampiniform plexus
Typically occur on left (because testicular vein drains into renal vein)
May be presenting feature of renal cell carcinoma
Affected testis may be smaller and bilateral varicoceles may affect fertility
when should a varicocele be managed NOT conservatively
If there are concerns about testicular function of infertility then surgery or radiological management can be considered.
how do you treat Testicular malignancy
Testicular malignancy is always treated with orchidectomy via an inguinal approach. This allows high ligation of the testicular vessels and avoids exposure of another lymphatic field to the tumour.
