Dr. Teo Zue Hiong
Content Hydrocele Hematocele Spermatocele & eppidydymal cyst Varicocele Testicular tumor Testic torsion Epidydymo-orchitis
Undescended testis
hydrocele
Excessive collection of fluid within tunica vaginalis
Divided into congenital & acquired (further divided into primary and secondary )
Congenital -patent connection with peritoneal cavity via patent
processus vaginalis
AcquiredPrimary:-Idiopathic-Can reach very large size with no pain
Secondary:-Trauma/infection/tumor-Small size. Tender if underlying testis tender
PE
Usually bilateral Translucent Testis impalpable
complication
Rupture Hematocele Infection Hernia of hydrocele sac Sac wall calcification Testic atrophic
hamatocele
Collection of blood within tunica vaginalis
Due to trauma or underlying malifnant
Not translucent (distinguished from hydrocele)
varicocele Dilated, tortuous & elongated veins of
pampiniform plexus of spermatid vein (varicose vein in spermatid cord)
90% on the left because Lt testicular vein drain into high pressure renal vein where the Rt testicular vein drains directly into IVC
Usually asymptomatic but pt usually infertile as it increases scrotal temperature which affect normal sperm function
Spermatocele & epididymal cyst Testis are palpable
Cant distinguished clinical. Only by aspiration.
-Spermatocele: slightly grey, opaque fluid containing spermatozoa
-Epidydymal cyst: clear fluid
Testicular tumor
20-40 years old >90% are derived from germ cells
Most common
-Seminomas: derived from spermatocyte
-Teratoma: dereved from 3 germ cell layer ectoderm/mesoderm/endoderm
Presentation
-solid testicular lump
- painless
- may cause secondary hydrocele
spread
Spread to para-aortic LN > thoracic duct > supraclavicular LN
Inguinal LN are not involved unless spread to scrotal skin
Investigation USG for scrotal content
Chest X-ray for lung secondaries
Tumour markero B-HCGo AFPo LDH
CT for staging
staging
I: confined to testis II: retroperitoneal LN III: metastasis above diaphragm
confined to LN IV: extralymphatic metastasis
treatment
orchidectomy Radiotherapy Chemotherapy LN dissection
Acute epidydymo- orchitis Primarily an infection of the epididymis
but then spread into testis
Organism : chlamydia/gonococcus/ E.coli
May be assoc with UTI
Presentation
Acute severe testicular pain Pain is decrease by raising the testis Scrotal skin red, hot & edematous
Aetiology and pathological features Rare,except a/w mumps Blood-borne infection Surgical procedure on the lower urinary
tract,e.g. TUR Organism: Neisseria gonorrhoeae,
Escherichia coli and Chlamydia. In young man, the commonest is Chlamydia
Tuberculosis
Clinical features
Preceding Hx of an operation or of dysuria, frequency and heamaturia
Acute pain in scrotum,swelling Epididymis:acutely tender and
enlarged(although it maybe difficult to differentiate from the equally tender testis)
Overlying redness and oedema maybe present
Investigation
FBC: leucocytosis Blood culture: helpful to direct antibiotic
treatment Urinalysis: pyuria, organism maybe
revealed by culture Aspiration of the epididymis USG: increased blood flow
Management
Bed rest,scrotal elevation Tetracycline or erthromycin Other antiobiotic refer to culture Partner should also be investigated and
treated
Epidemiology
Both testes are undescend in 30% of premature infants
Term:3% One year:1% Spontaneous descent after one year is
rare
Aetiology
Failure of migration along the normal line of descent
Ectopic testis:testicle deviates away from the line and lie in front of the penis in the superficial inguinal pouch,in the perineum or in the thigh.(reason unknown)
Risk factor Prematurity Low birth weight Twin gestation Down syndrome(fetus) or other chromosomal
abnormality Gestational diabetes mellitus Prenatal alcohol exposure Hormonal abnormalities (fetus) Toxic exposures in the mother Mother younger than 20 A family history of undescended testes
Clinical features
An empty scrotal sac or hemiscrotum at 1 year indicates:
Proximal to the external inguinal ring(undescended)
Truly absent Retractile-the cremaster muscle reflexly pulls the
organ up towards the inguinal canal Ectopic
Complication
Infertility:inevitable in bilateral and common in unilateral undescent,frequent in those who are undescent treated.
Torsion Trauma Inguinal hernia Malignant disease
Investigation USG,CT and laparoscopy
Management Target is to bring the testicle with its blood supply
into the scrotum as early as possible
Orchidopexy:should be done beyong puberty Testicular prosthesis can be placed in the
scrotum
1 Epididymis
2 Head of epididymis
3 Lobules of epididymis
4 Body of epididymis
5 Tail of epididymis
6 Duct of epididymis
7 Deferent duct (ductus deferens or vas deferens)
Testicular torsion occurs when the spermatic cord(from which the testicle is suspended) twists, cutting off the testicle's blood supply(ischemia)
Cause: recognised complication of testicular maldescent wherein the testis is inadequately affixed to the scrotum allowing it to move freely on its axis and susceptible to induced twisting of the cord and its vessels.
Occurs most probably between birth and early adolescence
Testicular torsion
Twist VS Untwist
Twist deprives the organ of its blood supply
If untwist does not take place within 6 hours,ischaemia is irreversible,gangrene develops and the testis either suppurates or atrophies
Presentation & Finding Acute severe testicular pain(affected side) Testis is tender,swollen and hang higher
up(compared to other side) Poorly localized central abdo pain Vomitting(sometimes) Scrotal skin become red,hot and edematous in
later stage Palpation may feel the twisted cord
Pain is increase or no improvement by raising the testis
Investigation
Urinalysis:sterile,acellular urine USG:absence of blood supply to the
affected testicle
Management
Surgical emergency Non-operative
Maybe possible to de-rotate the testis
Surgical Failure of non-operative reduction require
emergency operationThe testis is de-rotated and fixedThe gangrenous testis is removed
Dignosis of lumps in the scrotum1. Can u get above it? : if not, mostlikely is an
inguinoscrotal hernia.(or a hydrocele extending proximally)
2. Is it separate from the testis?3. Is it cystic or solid? Separate and cystic - epididymal cyst or
spermatocele Separate and solid - epididymitis (may also
orchitis) Testicular and cystic – hydrocele Testicular and solid – tumour, orchitis