Scrotal disorders

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undergraduate, Scrotal disorders

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Scrotal disorders

  1. 1. Urology Department Under-graduate coursesAcute and Chronic scrotal disorders
  2. 2. For our Lectures and Scientific resourcesvisit our web sites, Uroainshams.blogspot.com Uronotes2012.blogspot.com ©
  3. 3. Scrotal massesPainful Scrotal Mass Painless Scrotal MassTesticular torsion Testicular tumorEpididymitis HydroceleInguinal hernia Inguinal herniaTesticular tumor (rapidly growing) SpermatoceleTrauma (testicular rupture) Varicocele Paratesticular tumors ©
  4. 4. Scrotal mass• The single most helpful piece of information is whether the patient has pain.• A history of recent significant trauma also will narrow the diagnosis.• Color-flow Doppler ultrasound is the best test to aid in the diagnosis of scrotal pathology. ©
  5. 5. Testicular torsion • The classic presentation for testicular torsion is a sudden onset of pain that typically wakes the patient at night and is associated with abdominal discomfort and possibly vomiting. • The peak age is in adolescence. • On examination, the testis is usually very tender and often is riding high or lying abnormally as a result of shortening of the cord via the torsion. ©By Osama Heider, MBBcH Revised by M.A.Wadood , MD, MRCS
  6. 6. Testicular torsion- Management Diagnosis (primarly clinical diagnosis) plus • Scrotal dupplex shows affection or cut off of arterial blood supply to affected testicle Treatment • Mechanical detorsion is now obsolete. • Scrotal exploration as early as 6 hours to save the testicle or orchidectomy of devitalized testis. • Orchiopexy of other testis is done. ©By Osama Heider, MBBcH Revised by M.A.Wadood , MD, MRCS
  7. 7. Epididymitis and orchitis Pathology • Infection may involve epididymis alone (epididymitis), the testis alone (orchitis) or both organs (epididymo-orchitis). • The majority of cases of epididymitis have an infectious etiology, from urethra, prostate or bladder. Clinical features • pain and swelling of the scrotum. • urethral discharge. • Symptoms of UTI . • The epididymis and testis are swollen and impossible to distinguish Between them. ©By Ahmad El Awam, MBBcH Revised by M.A.Wadood , MD, MRCS
  8. 8. Epididymitis and orchitis Investigations and diagnosis The main differential diagnosis of epididymitis (and orchitis) is torsion of the testis . • Microscopic examination of the urine and/or urethral discharge may differentiate epididymitis from torsion. • Doppler ultrasonography evaluate blood flow to scrotum:  epididymitis is associated with increased blood flow whereas torsion results in decreased blood flow. • if there is any doubt about the diagnosis the testicles should be explored. ©By Ahmad El Awam, MBBcH Revised by M.A.Wadood , MD, MRCS
  9. 9. Epididymitis and orchitis Treatment • symptomatic treatment: bed rest, scrotal elevation and analgesics. • Antibiotics should always be given for up to 6 weeks to prevent relapse. ©By Ahmad El Awam, MBBcH Revised by M.A.Wadood , MD, MRCS
  10. 10. Testicular tumors• Testicular cancers usually are discovered as an incidental finding of a painless lump or nodule in the scrotum.• Commonly at age of 20 to 40 years.• The lump or nodule may be accompanied by a heavy sensation or dull ache in the lower abdomen.• They do not transilluminate, yet an associated hydrocele may occur. ©
  11. 11. Testicular tumors• Benign testicular tumors are rare (<1%) and include teratoma of childhood, epidermoid cyst, dermoid cyst, simple testicular cyst, and adenomatoid tumor.• Testicular ultrasound should be performed.• Treatment and pathologic diagnosis is made by radical inguinal orchiectomy.• Consider all testicular masses malignant until proven otherwise. ©
  12. 12. Inguinal hernia• An inguinal hernia often is first seen as a scrotal mass secondary to loops of bowel within the scrotum.• Indirect inguinal hernias may be secondary to a patent processus vaginalis or protrusion of a new peritoneal process along the cord into the scrotum.• Direct inguinal hernias result from weakness of the transversalis fascia at Hesselbachs triangle, rarely descending into the scrotum.• Complications include: inflammation, irreduciblity and strangulation. ©
  13. 13. Hydrocele• A hydrocele is a fluid collection within the tunica vaginalis surrounding the testis.• It presents as a painless swelling of the scrotum that transilluminates.• It often makes testicular palpation difficult and can conceal an underlying testicular tumor.• Surgery (hydrocelectomy) is indicated if complicated. ©
  14. 14. Congenital or Infantile Hydroceles• Congenital or infant hydroceles are usually the result of peritoneal fluid accumulation within the scrotum via a patent processus vaginalis and occur in 6% of full-term boys.• Their size often changes from day to day or with recumbency.• Treatment should be delayed during the first year of life because normal spontaneous closure of the processus vaginalis may occur.• After 1 year, surgical ligation of the processus vaginalis should be undertaken. ©
  15. 15. Adult acquired Hydroceles• Acquired or adult hydroceles are usually idiopathic but may be secondary to tumor, infection, or systemic disease.• Treatment is generally indicated to allow easy palpation of the testis or because of symptomatic discomfort or disfigurement.• Definitive therapy is surgical drainage and excision of tunica vaginalis. ©
  16. 16. Varicocele• abnormal dilatation of the veins of the pampiniform plexus and internal spermatic vein of the spermatic cord.• the most common cause of oligospermia.• unilateral (on the left) in 80% of patients.• bilateral in 18% of patients.• Varicocele have been reported in about 15% of the fertile male population.• varicocele is seen in 40% of infertile males. ©
  17. 17. Varicocele• Unilateral right-sided varico-celes are rare (noted in only 2% of cases) and should suggest the possibility of compression or obstruction of the inferior vena cava (e.g., tumor or thrombus).• Physical examination makes the diagnosis.• Dilated veins are best palpated with the patient standing and aided by a Valsalva maneuver.• Varicoceles have been described as feeling like a bag of worms. ©
  18. 18. Varicocele• The significance of a varicocele is its association with infertility.• Indications for varicocelectomy include oligospermia, decreased sperm motility, and a painful symptomatic varicocele. ©
  19. 19. Spermatocele• A spermatocele is an epididymal retention cyst that arises from the efferent ductules and holds a cloudy fluid containing spermatozoa.• It presents as a painless, cystic mass that lies above and anterior to the testis.• Ultrasound can confirm the diagnosis if doubt exists.• Treatment consists of spermatocelectomy and epididymectomy for extensive involvement.• Therapy should be avoided in young male patients concerned with fertility. ©
  20. 20. Scrotal Edema• Lymphedema of the scrotum can present as markedly enlarged bilateral scrotal sacs.Potential causes• include obstruction secondary to inflammation (filariasis, lymphogranuloma, tuberculosis, or syphilis), neoplasia, surgical procedures, or radiation.Diagnosis• History• Physical examination with transillumination of the scrotum (use high-intensity light source if available)• Color-flow Doppler ultrasound• Urinalysis ©
  21. 21. Thank YouBy M.A.Wadood , MD, MRCS

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