Excessive collection of fluid within tunica vaginalis
Divided into congenital & acquired (further divided into primary and secondary
Congenital patent connection with peritoneal cavity via patent processus vaginalis
Acquired Primary: -Idiopathic -Can reach very large size with no pain
Secondary: -Trauma/infection/tumor -Small size.
Tender if underlying testis Hydrocele- pathogenesis
• A hydrocele is an abnormal collection of serous fluid in a part of
the processus vaginalis, usually the tunica vaginalis. • A hydrocele can be produced in four different ways
1. By defective absorption of fluid -in primary hydrocele
2. By excessive production of fluid within the sac – in secondary hydrocele 3. By interference with lymphatic drainage of scrotal structures in filariasis 4. By connection with the peritoneal cavity via a patent processus vaginalis congenital Presentation Painless scrotal swelling Translucent Testis impalpable Complication of Hydrocele • Infection • Pyocele • Hematocele • Atrophy of testis • Hernia of hydrocele sac (rare) • Rupture • calcifications Rupture Management • surgery Complications of surgery
• Reactionary haemorrhage • Hematocele • Infection • Pyocele • Sinus formation • Recurrent hydrocel • Hydrocele of the canal of Nuck is a condition in females.
• The cyst lies in relation to the
round ligament and is at least partially within the inguinal canal Heamatocele
Collection of blood within tunica vaginalis
Due to trauma or underlying malignant
Not translucent (distinguished from hydrocele)
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 Spermatocele & Epididymal cyst
Testis are palpable
Can ‘t distinguished clinical.
Only by aspiration. -Spermatocele: slightly grey, opaque
fluid containing spermatozoa -Epidydymal cyst: clear fluid Us scan may help Epididymal cyst Epididymal cyst • Cystic degeneration of the epididymis • Common, multiple ( bunch of grapes), • B/L , middle aged Transilluminate, • testis could be felt, can get above
• USS help you
Management Conservative • Aspiration is useless • Excision- partial/ total epididymectomy- risk • Spermatococele- unilocular , retention cyst, epididymis , contains sperms- barley water Chronic epididymo-orchitis Acute epidydymo- orchitis Primarily an infection of the epididymis but then spread into testis
Organism : chlamydia/gonococcus/ E.coli
May be assoc with UTI Presentation
Acute severe testicular pain and swelling
Pain is decrease by raising the testis Hx of dysuria, frequency and heamaturia
Scrotal skin red, hot & edematous
Epididymis:acutely tender and enlarged(although it maybe difficult to differentiate from the equally tender testis) Aetiology and pathological features
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 Investigation
FBC: leucocytosis
Urinalysis: pyuria, organism maybe revealed by culture
Blood culture: helpful to direct antibiotic treatment
USG: increased blood flow
Management
Bed rest, scrotal elevation
antibiotic refer to culture
Partner should also be investigated and treated for
underline causes if it is recurrent Testicular Torsion Testicular torsion occurs when the spermatic cord(from which the testicle is suspended) twists, cutting off the testicle's blood supply(ischemia)
Cause: 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
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 Presentation & Finding
Acute severe testicular pain(affected side)
Testis is tender, swollen and hang higher up(compared to other side)
Poorly localized central abdominal pain
Vomitting(sometimes) Scrotal skin become red, hot and edematous in later stage Palpation may feel the twisted cord Transversely placed testis Pain is increase or no improvement by raising the testis Investigation
USG: absence of blood supply to the affected testicle
Management
Surgical emergency Maybe possible to de-rotate the testis. Failure of non-operative reduction require emergency operation The testis is de-rotated and fixed
The gangrenous testis is removed
Torsion of the testicular appendages Undecending testis Undescending testis Epidemiology
Both testes are undescended in 30%
of premature infants Term: 3% One year: 1% Spontaneous descent after one year is rare 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) 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 Clinical features
• An empty scrotal sac or hemiscrotum
indicates: • Proximal to the external inguinal ring(undescended) • Truly absent • Retractile-the cremaster muscle reflexly pulls the organ up towards the inguinal canal • Ectopic (mal Descended) Complication • Infertility: inevitable in bilateral and common in unilateral undescent
Management Target is to bring the testicle with its blood supply into the scrotum as early as possible
Orchidopexy: should be done beyond puberty
Testicular prosthesis can be placed in the
scrotum varicocele • Dilatation of pampiniform plexus • 15-20% • 905 left side • Ideopathic, tumour • Asymptamatic, dragging pain, on standing • Cough impulse, testicular atropy • Us scan Skin infection Fournier’s Gangrene • Necrotizing fasciitis- soft tissue of perineum, external genitalia, perianal region • High mortality - 50% • Polymicrobial • Post abrasion/ trauma/ ST injection/ urethral dilatation/ DM/ Alcohol
• Pain, fever, cellulitis, necrosis, crepitus and features of sepsis
• Surgical emergency- WT, IV Abx, Vac/ skin graft later Sebaceous cyst of the scrotum Dignosis of lumps in the scrotum
1. Can u get above it? : if not, most likely 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, orchiti Penile benign and malignant conditions Phimosis • Prepuce is adhered to glans at birth, disappear at 2 years, may be till 6 y (physiological) • Boys- due to scarring, Balooning, balanoposthitis, narrow aperture • Adults- scarring- balanitis, posthitis , BXO (lichen sclerosis atrophicus) paraphimosis Penile pearl Hypospaediasis Peyronie’s disease • Idiopathic penile deformity • penile plaques, pain on erection , prevent penetration • (25%) associated with Dupuytren’s contracture • Surgery • Collagenase injection • Genital warts/ condylomata accuminata – STD, HIV associated , HPV 6,11- podophyllin LA, Imidaquod, Cryosurgery, laser, electrosurgery, circumcision Thank you
