SC

Scrotal masses

Scrotum: sac wich holds the testis. Venous drainage: pampiniform plexus >> gonadal vein>> Rt. To IVC & Lt. to Lt. renal vein. Lymphatic drainage: Paraortic lymph nodes.

Covering of the testis: - Tunica albugenia: (inner) cant be separated from testis - Tunica vaginalis: (outer) - cremasteric ms.

1- hydrocele:

Def: Fluid within Tunica or Processus vaginalis

Etiology: Primary (most common without known cause) Secondary: - Injury infection e.g (epidydmitis) tumor

Clinical Picture: Symptoms: painless Swelling, pt may report sensation of heaviness end fullness Examination:

Fourth year This note is NOT enough... Please refer to the book
1

2009 integrated system

SC
Mass cystic not tender **In children almost always ass. With hernia. _transilluminate test. Investigation: Scrotal Ultrasound

Types: Infantile (communicating) Vaginal (Simple) Encysted hydrocele of the cord

2-Spermatocele
Def: benign cystic accumulation of sperm that arise from head of the epididymis Cystic mass Above & posterior to testis Painless mass Transilluminate contains Sperms

3-Varicocele
Def: Dilatation of pampiniform plexus Left > right (higher venous pressure in the Lt Side) Examine: supine & erect **If its present in erect position then disappears in supine position>> varicocele

Fourth year This note is NOT enough... Please refer to the book
2

2009 integrated system

SC
**If it doesnt disappear in supine position>> obstruction of the renal vein due to renal cell carcinoma which invaded the renal vein Infertility: the most common cause of male infertility present in 35% of infertile men

4-Orchitis
Def: Painful condition of testis involving inflammation, swelling and frequent infection of the testis Etiology: Epididymitis Mumps (particularly in adolescent) _STD (syphilis, Chlamydia , gonorrhea) hematogenous

5-Testicular Tumors
Young patient Cuases: Undescended testis Types:

Histological Types of Testicular Tumors: refer to the sheet

Metastasis:

Fourth year This note is NOT enough... Please refer to the book
3

2009 integrated system

SC
LN, Lung, Liver Clinical Picture Symptoms: enlargement (+/-pain) back pain, hydrocele Signs: hard mass no tenderness ?hydrocele gynecomastia Tumor marker: B-HCG & alpha-fetoprotein

6-Testicular Torsion
Def: twisting of the spermatic cord Children or adolescents emergency Pathology: Rotation>> venous occlusion>> swelling Arterial occlusion>> necrosis ( testis death occur in 6 h duration) Bilateral tendency: if pt. once had it in LT. Side, he may develop torsion in RT side in the future >> in surgery we fix both.

Symptoms: Pain: sudden & severe Swelling Nausea & vomiting Lower abdominal or inguinal pain

Examination: Tenderness

Fourth year This note is NOT enough... Please refer to the book
4

2009 integrated system

SC
Swelling Elevated (short spermatic cord due to rotation) Redness

7-Epididymitis
Def:Inflammation of the epidydimis mostly duo to infection Etiology STD: (C. Trachomatis then Gonorrhea) in sexually active men UTI (most common cause) T.B. Clinical picture: Symptoms: pain (gradual) - swelling-other sym. Of UTI -? Fever Signs: swelling- redness tender-+/- hydrocele -urethral discharge

8-Cryptorchidism (UDT)
Def: Absence of 1 or both testicles from the scrotum duo to failure of testis to move or descend during fetal development. Etiology: defect in: Gubernaculum Testicular defect or or

Hormonal defect (maternal) C/P: Scrotum: small & empty Complications:

Fourth year This note is NOT enough... Please refer to the book
5

2009 integrated system

SC
Tumor ((increase the risk of development even if the repair occurs within the 1st 2 years of life)) trauma, hernia, torsion, infertility. **If discovered during 1st year >> leave it till the end of 1st year cause it may descend spontaneously ** if its surgically repaired before 2 years >> damage is reversible.

9-Retractile Testis
Def: descended testis that easily move back and forth between the scrotum and abdomen

Examination: Well developed scrotum Testis in the inguinal region BUT can be Brought to bottom of scrotum

Scrotal mass:
1-Scrotal: a. Testis & epidydimitis are definable>>*transilluminate: - Epidydimal cyst >> *opaque: -Tumor -epidydimis b. Testis & epidydimitis are not definable >> *trasilluminate: -hydrocele >>*opaque:

Fourth year This note is NOT enough... Please refer to the book
6

2009 integrated system

SC
-epidydimis - Torsion - hematocele (blood in scrotum usually after trauma)

2-Inguinoscrotal: -hernia -varicocele -infantile hydrocele

Fourth year This note is NOT enough... Please refer to the book
7

2009 integrated system