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Non malignant scrotal disease (Hydrocele (Symptoms (No pain, Scrotal…
Non malignant scrotal disease
Varicocele
Clinical Presentation
The pampiniform plexus will appear to be like a bag of worms .
Dull ache and heaviness
Differential Diagnosis :
secondary tumor of the kidney obstructing venous drainage
Cause
Increased reflux back from a renal vein compression
Lack of effective testicular and renal vein valves
More common in the left as there can be a difference in the angle at which the testicular vein enters the left renal vein.
Epidemiology:
More common in the left testis
Incidence happens post puberty
Uncommon in boys under 10 years old
Causes problems with fertility later on in life
Definition: this is when there is an abnormal dilation of the veins in the pampiniform plexus . This is generally more common i n the left testicle as it drains into the left renal vein
Diagnosis
Doppler color ultrasound
Venography
Treatment
Surgery
Epididymal Cyst:
Epidemiology
Normally benign- treatment isn't necessary
common in the head of the epididymis
Presentation is normally in 40s and are common in puberty as well
The cyst will present above and behind the testis
Definition: this is a separate and cystic feeling lump that is found in the scrotum. It is normally a thin walled structure that incases a liquid. In some cases dead sperm (spermatocele)
Symptoms
Tender
Pain
Swollen
Signs
Bigger the size more symptomatic
Multiple and bilateral
Diagnosis
Ultrasound
Aspirate
Treatment
Surgery
NOTE: associated with cystic fibrosis and prostatic kidney disease
DD
Hydrocele
Varicocele
Spermatocele
If a patient presents with a scrotal/ testicular lump it is presumed cancerous until otherwise.
Lump separate and cystic: epididymal cyst
Separate and solid (scrotum); varicocele
Acute tender enlargement: is presumed testicular torsion until proved otherwise
Testicular and cystic: hydrocele
Testicular and solid: tumour
Hydrocele
Epidemiology : 6% of the time males are beyond the newborn period. Most pediatric hydrocele are congenital
Aetiology
Primary hydrocele: more common and are larger. They are associated with a patent processes vaginalis. Resolves after a year
Secondary hydrocele: are rare and present in older boys and men . They are normally caused by trauma, infection or a testis tumor. More obscure problems can be testicular torsion or TB
Definition: ABNORMAL fluid collection in the tunica vaginalis
Pathophysiology
In
primary hydrocele
there is a failure for the processes vaginalis to close. This means that there is a connection point for peritoneal fluid to communicate through the processus vaginalis
Secondary hydrocele: an over production of fluid in the tunica vaginalis
Symptoms
No pain
Scrotal swelling- non tender
Difficulty with movement
Signs
Palpable testis
Smooth cystic scrotal swelling
Transluminate the testis and fluid is found anterior and below the testis
Differential Diagnosis
Testicular torsion
Strangulated Hernia
Diagnosis
Ultrasound - transluminate the tumor
Serum alpha fetoprotein and hCG to exclude tumors
Treatment
Resolve by themselves
Aspirate
Surgery