1. Painless testicular swellings can have many potential causes including hydrocele, varicocele, inguinal hernia, spermatocele, epididymal cyst, lymphedema, and testicular tumor. 2. A thorough history and physical exam including inspection of the scrotum and examination of the testes is needed to determine the cause. 3. Differential diagnosis and appropriate testing or imaging may then be used to confirm the diagnosis and guide treatment.

1. Painlesstesticular
swellings

2. Anatomy

5. Evaluation

6. time of onset,
associated symptoms
(especially pain),
and previous episodes
History

7. •
•
•
•
•

8. The epididymis is
posterolateral to the testicle;
the epididymis and testicle
are separated but attached.
The vas deferens emanates
from the tail of the epididymis
and joins the vascular pedicle
of the testicle to form the
spermatic cord.

9. Inspection:
the Site,
Size,Shape,
Symmetry, Skin changes,
and any Scars present.

10. Tenderness, Temperature,
Transillumination,
Consistency, Attachments,
Mobility, Pulsation,
Fluctuation, Irreducibility,
Regional lymph nodes,
and the Edge.

11. Differential
diagnosis

12. Torsion testis
Ruptured testis
Torsion of testicular
appendages
Complicated hernia
Acute epididymo-orchitis
Painful

13. painless
Hydrocele
Varicocele
Inguinal hernia
Spermatocele
epididymo-
orchitis
Testicular
tumor
Epididymal cyst
lymphedema

15. Hydrocele

18. abnormal collection of fluid between the
parietal and visceral layers of the tunica
vaginalis
painless
fluctuant swelling
you can palpate spermatic cord
that will transilluminate

20. Treatment
Plication:
for thin-walled
hydroceles.
the tunica being
bunched into a ruff
by applying a series
of multiple
interrupted chromic
catgut sutures for
the sac to form
fibrous tissue.
Exiction and
evertion:
thick-walled
hydroceles
subtotal excision of the
tunica vaginalis and
everting the sac behind
the testes followed by
placing the testes in a
newly created pocket
between the fascial
layers of the scrotum

21. varicocele

23. •
•
•
•
•

27. Inguinal
hernia
“complete”

29. • Increases in size when upright or when intra-
abdominal pressure increases
• reducible or compressible
• Possibly bowel sounds
• Absence of normal spermatic cord structures above the
mass
• Possibly palpable in the inguinal canal

30. Treatment
• Herniotomy: in children
excition of the sac
• Herniorrhaphy:
Mercy repair
Bassini repair
Shouldice repair
• Hernioplasty: using mesh
In old age and in recurrence.

31. spermatocele

32. Acquired retention cyst due to blocked sperm
conduction in epididymis.
Soft and cystic ( N.B. cyst of epididymis itself is tense )
pateint considers it as a 3rd testis; found above and
behind testis.
Unilocular in palpation

34. Confirmation
and
treatment
•
•
•

35. Epididymal cyst

36. Cystic Degeneration of para
epididymis ,appedices of epidiymis or
testis.
Often BI.
Feels like a bunch of tiny grapes-
Multilocular-.
Felt completely separate from body of
the testis.
Chinese letter pattern in
transillumination.

38. Treatment
•
•
•

39. lymphedema

40. •From: filariasis, congenital,
idiopathic, after pelvic radiation or
cancer [eg, prostate, bladder,
testicular]
•Diffuse swelling
•Non pitting)

42. Testicular
tumor

43. Testicular
tumors
Germ cell tomors
95%
Non germ cell 5% Secondary
tumor
seminoma
Non
seminoma
Embryonal
carcinoma
teratoma
Testicular
choriocarcino
ma
Yolc sac
carcinoma
Mixed cell
Leydig
cell
tumors
Sertoli
cell
tumors
lymphoma

44. Mass attached to or part of testis
solid
 does not transilluminate
By:
• Ultrasonography of scrotum
• Alpha-fetoprotein
• Beta-human chorionic gonadotropin
• Lactic dehydrogenase
• CT of the abdomen
• histopathology

46. •
Determined by the location, size, and histology of the tumor
• Chemotherapy
• radiation therapy
• , and/or surgical resection
• The 5-year survival is ∼ 95% for seminomas
and 45–60% for nonseminomas