SCROTAL

PATHOLOGIES

Dr. Shoaib Muhammad FCPS

Senior registrar general surgery
Muhammad teaching hospital
OBJECTIVES
• Learn about various surgical pathologies of scrotum
• Differentials of various swellings
• Schematic management of various pathologies
 Causes of Scrotal swelling
ACUTE PAINFUL CHRONIC PAINLESS

Torsion testis Hydrocele

Acute epididymo orchitis Epididymal cyst

Torsion of testicular Spermatocele

appendages

Chronic epididymoorchitis

Testicular tumor

Varicocele
CASE SCENARIOS
CASE 1
SCENARIO
• A 35-year old male patient presents with right sided scrotal swelling
of two years duration. It is a progressively increasing painless swelling.
• O/E: the right side of the scrotum shows a swelling of 15 x 10 cm size
which is confined to the scrotum (can get above the swelling).
• The surface of the swelling is smooth and borders are well-defined.
• There is no local rise of temperature.
• The swelling is fluctuant and transilluminant.
• It is not reducible. There is no cough impulse.
Continued..
• The right testis is not felt separately. On percussion it is dull
• The spermatic cord is felt above the swelling and is tender.
• The contralateral testis and genitalia are normal.
• There is no evidence of any mass or lymph nodes in the abdomen

• DIAGNOSIS???
HYDROCELE
Hydrocele- Etiopathogenesis
• 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 excessive production of fluid within the sac→ in secondary
hydrocele
• 2. By defective absorption of fluid in primary hydrocele
• 3. By interference with lymphatic drainage of scrotal structures → in
filariasis
• 4. By connection with the peritoneal cavity via a patent processus
vaginalis in congenital hydrocele
CASE 2
SCENARIO
• • A 14-year-old boy presents with acute onset of right scrotal and RLQ
pain for the past 4 hours. He additionally reports nausea and one
episode of vomiting. He denies any similar past pain and reports no
history of trauma.
• O/E: the skin overlying the right side of the scrotum appears to be
slightly erythematous and edematous.
• The right testicle appears to be lying significantly higher in the
scrotum as compared to the left testicle.
• The entire right testicle is exquisitely tender to palpation, whereas the
left one is nontender
• He has an absent cremasteric reflex on the right.
TESTICULAR TORSION
CASE 3
SCENARIO
• A 45 years old male patient presented with a swelling in right side of the
scrotum for last 3 years which is increasing very slowly insize. There is no
pain over the swelling.
• O/E: There is a soft cystic swelling in relation to the head of the right
epididymis.
• The swelling has a lobulated surface and feelslike a bunch of grapes.
• Testis can be felt separately from the swelling
• The swelling is brilliantly transilluminant and has Chinese lantern pattern
appearance
EPIDYDIMAL CYST
CASE 4
SCENARIO
• 30 years male patient presented with a swelling in the left side of the
scrotum for lașt 4years.
• The swelling started in the lower partof the scrotum and
subsequently the swelling is slowly increasing in size and grown up to
the root of the scrotum. The swelling disappears on lying down
position and reappears on standing andwalking
• Patient complains of dull aching pain in the left side of the scrotum for
last 6 months, the pain is more towards the evening when theswelling
enlarges in size
• There is no pain abdomen, no urinary complaints
Continued...
• O/E:
• A mass of dilated vein feeling like a bag of worms is palpable on the
left side of the scrotum along the left spermatic cord extending from
the upper pole of the testis up to the superficial inguinal ring
• No expansile impulse on cough is palpable, instead a thrill ispalpable.
On lying down and on elevation of the scrotum the swelling
disappears On asking the patient to stand up the dilated veins
reappeared.
• The left testicular volume is smaller than the right one.
• Abdominal examination is normal
 ASSIGNMENT
• Study testicular carcinoma from Baily and Love.
• Classification
• Clinical features
• Workup
• Management

• Submit your assignments hand written till 10th Oct 2020

• Assignments marks will be added to internal assessment