Scrotal swelling
Tortion of spermatic cord
SCROTAL SWELLING
Scrotal swelling with pain:
Scrotal Swelling without pain:
Testicular torsion
within 6h gangrene
occur)
Epididymo-Orchitis
Testicular trauma
Incarcerated scrotal hernia
Testicular tumor(10%)
Hydrocele
Spermatocele
Varicocele
Hematocele
Scrotal hernia
Testicular tumor(90%)
Torsion of testis
Epididymo-orchitis
Sudden severe pain
Gradual, few days
No
Constitutional symptoms (fever ,
malaise …)
No
Irritative symptoms
Testis lie transversely at the neck
of scrotal sac
Hanging down
No
Elevation of testis relieve pain
Loss of cremasteric reflex
Less reflex but not lost
No
Signs of inflammation on the
scrotal wall
Ix:GUE is free
Not elevated(EARLY)
Doppler u/s:absence of blodd
supply to the affected testis
Ix: GUE shows signs of UTI
WBC count
doppler u/s : normal blood
supply
Tx:torsion=exploration
If viable testis,do orcheopexy
If gangrenous, do orchidectomy
-The other testis should also be fixed
because the anatomical predisposition
is bilateral
-In the first hours it may be possible to
untwist the testis manually, then early
Tx:first do culture then give
Third generation cephalosporins
+ quinolone + IV FLUID +
analgesics+antipyretic + anti-
emetic +drainage of abscess if
occur
-
, ويٌح داضم انٌطنا, جلاعلا انٌدب
وكان, عرزلا ةجٌتن تعلط موٌ ًناث
orcheopexy to avoid recurrent torsion
-
)اذا ما كدرنا نميز بين االثنين(فقط فرضيا
نسوي
Exploration
فاذا طلع
Torsion , we are O.K,
واذا طلع
Epididymo-orchitis
نرجع نخيط وماكو اي مشكلة
الن الكانكرين بالتورشن فقط
6
ساعات
ويصير
, نٌجوثابلا ىلع لغتشٌ ام يوٌحلا داضملا
ض استفاد منٌرملا تقولا سفنب سب
) العالج(خفت الحرارة و...الخ
بهاي الحالة نستمر على نفس المضاد
ويٌحلا
-
ويٌحلا داضملا قباطٌ عرزلا ناك اذا
ض ما تحسن بهايٌرملا سب , ىطعملا
الحالة نسوي
Revision of Hx and EX
+اخذ عالجٌ ضٌرملا نا نم دكاتن +
If abscess occur , drainage.
The most important investigation to differentiate Doppler
U/S(exam)
Causes of tortion(exam):1-spontaneously during sleep
2-straining at stool,lifting a heavy
weigt,trauma,coitus are risk factors
For epidedymo-orchitis(exam):
-E.coli is the most common cause
-most common viral infection causing it :mumps
-complication:
1-
testicular atrophy 2-infertility if the condition is
bilateral
Hydrocele (vaginal)
Hernia
HX :non reducible(swelling
always fixed)
Hx: reducible(disappair and
reappair)
Dragging point
Dragging point
EX:non resucible
Can get above it
Transillumination test +
Couph impulse -
Ex: reducible
Can not get above it
-
+
Ix:U/S shows clear fluid
around testis
Ix:U/S shows tissues or gas
around testis
Tx: surgical excision
Tx:surgical(herniotomy,
hernioplasty,herniorrhaphy)
EXAM slide : dark room with light applied to testis
which appear red test?transillumination
test+Dx?hydrocele
+most common age? most common in
middle and later life but can also occur in older children
Transilluminatin test
scrotal u/s of hydrocele
Scrotal Doppler u/s of varicocele
Q on varicocele:
commom age?adolescence and early adulthood
commom side?left
diagnostic test? Scrotal Doppler U/S
tx ?1- asymptomatic:conservative
•
2-surgery(open ligation , laparoscopic ligation
,Embolisation of the testicular vein under radiographic
control)
3-indication for syrgery: pain, infertility, cosmetic
c/f: لالطالع
• Usually symptomless
• dragging scrotal discomfort
• scrotum on the affected side hangs lower than normal
• On palpation varicose plexus feels like a bag of worms
C/f
• The scrotum is empty & underdeveloped
• More common on the right
• Bilateral in 20% of cases.
• Secondary sexual characteristics are typically
normal. كون طفل وغالبا عمره اقل منٌ ضٌرملا هنا هبتنن ًش مها
6
سنوات
hazards
• Sterility in bilateral cases
• Pain as a result of trauma
• Indirect inguinal hernia often present
• Torsion of the testis
• Epididymo-orchitis
• Atrophy
• Testicular cancer
1-Orchidopexy
is usually performed
after the age of one
year
(The testes should be brought down into the
scrotum before the boy starts school.)
2-Orchidectomy(if
atrophic
)
3-human chorionic gonadotrophin (if
hypogonadism)