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Other scrotal swelling by Dr. Teo
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Other scrotal swelling by Dr. Teo


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  • 1. Dr. Teo Zue Hiong
  • 2. Content Hydrocele Hematocele Spermatocele & eppidydymal cyst Varicocele Testicular tumor Testic torsion Epidydymo-orchitisUndescended testis
  • 3. hydrocele Excessive collection of fluid within tunica vaginalis Divided into congenital & acquired (further divided into primary and secondary )
  • 4.  Congenital -patent connection with peritoneal cavity via patent processus vaginalis AcquiredPrimary:-Idiopathic-Can reach very large size with no painSecondary:-Trauma/infection/tumor-Small size. Tender if underlying testis tender
  • 5. PE Usually bilateral Translucent Testis impalpable
  • 6. complication Rupture Hematocele Infection Hernia of hydrocele sac Sac wall calcification Testic atrophic
  • 7. hamatocele Collection of blood within tunica vaginalis Due to trauma or underlying malifnant Not translucent (distinguished from hydrocele)
  • 8. 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
  • 9. Spermatocele & epididymal cyst Testis are palpable Cant distinguished clinical. Only by aspiration.-Spermatocele: slightly grey, opaque fluid containing spermatozoa-Epidydymal cyst: clear fluid
  • 10. 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
  • 11. Presentation-solid testicular lump- painless- may cause secondary hydrocele
  • 12. spread Spread to para-aortic LN > thoracic duct > supraclavicular LN Inguinal LN are not involved unless spread to scrotal skin
  • 13. Investigation USG for scrotal content Chest X-ray for lung secondaries Tumour markero B-HCGo AFPo LDH CT for staging
  • 14. staging I: confined to testis II: retroperitoneal LN III: metastasis above diaphragm confined to LN IV: extralymphatic metastasis
  • 15. treatment orchidectomy Radiotherapy Chemotherapy LN dissection
  • 16. Acute epidydymo- orchitis Primarily an infection of the epididymis but then spread into testis Organism : chlamydia/gonococcus/ E.coli May be assoc with UTI
  • 17. Presentation Acute severe testicular pain Pain is decrease by raising the testis Scrotal skin red, hot & edematous
  • 18. Aetiology and pathologicalfeatures 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
  • 19. 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
  • 20. 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
  • 21. Management Bed rest,scrotal elevation Tetracycline or erthromycin Other antiobiotic refer to culture Partner should also be investigated and treated
  • 22. Epidemiology Both testes are undescend in 30% of premature infants Term:3% One year:1% Spontaneous descent after one year is rare
  • 23. 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)
  • 24. 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
  • 25. Clinical featuresAn 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
  • 26. Complication Infertility:inevitable in bilateral and common in unilateral undescent,frequent in those who are undescent treated. Torsion Trauma Inguinal hernia Malignant disease
  • 27. Investigation USG,CT and laparoscopyManagement 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
  • 28. 1 Epididymis2 Head of epididymis3 Lobules of epididymis4 Body of epididymis5 Tail of epididymis6 Duct of epididymis7 Deferent duct (ductus deferens or vasdeferens)
  • 29. Testicular torsion Testicular torsion occurs when the spermatic cord(from which the testicle is suspended) twists, cutting off the testicles 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
  • 30. 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
  • 31. 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 cordPain is increase or no improvement by raising the testis
  • 32. Investigation Urinalysis:sterile,acellular urine USG:absence of blood supply to the affected testicle
  • 33. Management Surgical emergency Non-operative Maybe possible to de-rotate the testis Surgical Failure of non-operative reduction require emergency operation The testis is de-rotated and fixed The gangrenous testis is removed
  • 34. 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