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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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