Scrotal Swelling2

7/27/2019 Scrotal Swelling2

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Scrotal SwellingBy

Anwar Ali Showail


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Varicocele

Is due to incompetent

valves in the testicular

vein, permitting

transmission ofhydrostatic venous

pressure; distention

and tortuosity of the

pampiniform plexusresults.


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Cont,varicocele

Very common about 20-30% of normal

population will have some degree of

varicocele.

More common on left side in 98% of cases.

Bilatral in in up to 50% of cases.


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Cont,varicocele

S&S:

1. Appear on standing and disapear on lying

down.2. Heavy or dragging sensation in scrotum.

3. The veins often described as bag of

worms but feeling like a plate of lukewarmspaghetti.

4. The affected testes may be small.


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Cont,varicocele

5. Bilateral varicocele may cause subfertility.

6. Be caution that a sudden onset of a left

varicocele which does not disapear onlying down in old patient may be due to an

obstruction of left renal vein by a renal

carcinoma.


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Cont,varicocele

Dx: Clinical and USS.

Rx:

No treatment required in asymptomatic. If symptomatic so intervention required

either by embolization and oblitration under

radiological control or if surgery indicated itis via inguinal approach,all testicular veins

being ligated at deep inguinal ring.


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Epididymal cyst

(spermatocele)

Cysts arise from diverticula of the vasaefferentia, they are fluid filled cystsconnected with epididymis.

May be small ,large ,multiple, uni or bilateral.

Usually occur over 40y.o.

S&S: Scrotal swelling, slowly enlarges,

painless. Lie above and slightly behind the testes.

You can get above it.


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Epididymal cyst


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Infections of testis &

epididymis

May be acute or chronic.

Acute or chronic orchitis may be due to

mumps.Acute epidiydmo-orchitis may be due to

coliform organisms or gonorrhoea.

Also can follow instrumentation or operationson prostate.

Cronic epididymo-orchitis may follow acute

attack or more commonly is due to TB.


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Infections of testis &

epididymis

S&S: pain, swelling redness of the scrotum,

often associated with pyrexia.

In children defferentiation from torsion isoften impossible and scrotum should be

explored.

Enlarged exuisitely tender testis andepididymis.


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Cont.

Investigation: FBC, MSU, Early morning

urine specimens for TB culture.

Rx: Acute: Bed rest. Analgesia. ABx:

ciprofluxacin until C&S.

Chronic: TB-antituberculous drugs.Orchidectomy if fails. Long ABx treatment for

non tuberculous epididymo-orchitis.


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Cont.

It is associated

imperfectly descended

testis, or high

investmnt of tunicavaginalis with a

horizontal lie of testis,

or when the epididymis

and testis areseparated by a

mesochorium.


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Cont.

S&S:

Sudden onset of severe pain in the scrotum

and groin and radiating to the lowerabdomen associated with vomiting.

Swollen, painful, testis drawn up to the groin.

Difficult to differentiate from epididymo-orchitis (fever, leukocytosis and testis is not

drawn up to the groin).


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Cont.

If you in doubt in case

of acute painful

scrotum so the scrotum

must be explored. If untreated infarction

of testis will result.

Untwisting should becarried on within 6 hrs.

of symptoms.


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Cont.

Rx: EMERGANCY

Explore the testis.

Untwist the testis.

If viable so fix to

scrotum by anchoring it

to scrotal septum and if

the other testis isabnormal fix it.

If infracted so remove

it.


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Testicular trauma

Usually in sports injuries or violance.

may result in bleeding into the layers of

tunica vaginalis resulting in haematocele. S&S: severe pain, scrotal swelling, bruising,

tender, enlarged testis.

Invx: scrotal ultrasound (beware of anunderlying malignancy).


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Cont.

Rx:

Bed rest

Scrotal support Surgical exploration may needed to evcuate

the haematocele and to repair the split in

tunica albugenea.


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Testicular cancer

The commonest malignancy in young men.

90% arise from germ cells and are either

seminomas or teratomas. 10% are lymphomas, sertoli cell tumours or

leyding cell tumours.


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Cont.

Seminomas in 30-40y.

Teratomas in 20-30y.

Imperfectly descended testes have a 20-30times increased incidence of malignancy.


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S&S:

Painless swelling of the testis.

Heaviness in the scrotum. May be Hx of trauma.

Palpable abdominal mass.

Spread to para-aortic nodes and to leftsupraclavicular node.

Chest symptoms due to metastases.


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Investigations:

USS testis

CXR Tumour markers: AFP, HCG

CT scan


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Scrotal Swelling2

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