What is the most common type of scrotal swelling seen in primary care?
Epidydimal cysts
What are some features of epididymal cysts?
- Separate from the body of the testicle
- Found posterior to the testicle
What are some conditions associated with epididymal cysts?
- Polycystic kidney disease
- Cystic fibrosis
- Von Hippel-Lindau syndrome
How do you diagnose epididymal cysts?
USS
How do you manage epididymal cysts?
Management is usually supportive but surgical removal or sclerotherapy may be attempted for larger or symptomatic cysts.
What is a varicocele?
The accumulation of fluid in the tunica vaginalis
What are the two different types of hydrocele?
- Communicating: caused by patency of the processus vaginalis allowing peritoneal fluid to drain down into the scrotum.
- Common in newborn males and usually resolve within the first few months of life.
- Non-communicating: caused by excessive fluid production within the tunica vaginalis.
Hydroceles can develop secondary to what conditions?
- Epididymo-orchitis
- Testicular torsion
- Testicular tumours
What are some features of Hydroceles?
- Soft, non-tender swelling of the hemi-scrotum. Usually anterior to and below the testicle
- The swelling is confined to the scrotum, you can get ‘above’ the mass on examination
- Transilluminates with a pen torch
- The testis may be difficult to palpate if the hydrocele is large.
How do you diagnose hydroceles?
Diagnosis may be clinical but ultrasound is required if there is any doubt.
Further investigation (USS) to exclude any underlying secondary cause such as a tumour
How do you manage hydroceles?
- Infantile hydroceles are generally repaired if they do not resolve spontaneously by the age of 1-2 years
- In adults a conservative approach may be taken depending on the severity of the presentation.
What is a varicocele?
An abnormal enlargement of the testicular veins.
What side are they more common in (left or right) and what are their features?
- The left side. (>80%)
- Classically described as a ‘bag of worms’
- Subfertility
How do you diagnose varicoceles?
Ultrasound with Doppler studies
How do you manage varicoceles?
- Usually conservative
- Occasionally surgery is required if the patient is troubled by pain.
- There is ongoing debate regarding the effectiveness of surgery to treat infertility
