Do hydroceles require treatment?

Generally, no

(unless they become very large)

Which scrotal masses transilluminate?

Hydroceles

  &

Spermatoceles

What is a spermatocele ?

A fluid collection in the outbound ducts of the scrotum

How can you identify a spermatocele?

1. Transilluminates

2. Doesn’t change with Valsalva

 (varicocele would)

(hernia would)

3. Mass is behind & above testis

If something on the scrotal exam is described as being like a “bag of worms,” what is the mass?

A varicocele

(dilated, tortuous veins)

What is a varicocele ?

Dilated veins in the scrotum

(usually left sided)

Which veins are dilated in varicoceles?

The “pampiniform” plexus

(of the scrotum)

How do you identify a varicocele?

• Usually left sided

• “Bag of worms” consistency

• Increased size with Valsalva

• Decreases when lying down

Does a varicocele require treatment?

If the testis becomes hypotrophic or if sperm count decreases –

Yes

(otherwise, no)

Is treatment needed for spermatoceles?

No

Do spermatoceles affect fertility?

No

What is a hematocele ?

Blood in the scrotal sac due to trauma

Do hematoceles require treatment, and if so, what is it?

• If they become very large, then yes

• Surgical drainage

How are hematocele symptoms treated?

Pain meds

Ice packs

Scrotal elevation/bed rest

If a testicular neoplasm develops, is it usually painful or painless?

Painless

Why might a testicular tumor patient present with back pain?

Retroperitoneal LAD (associated with tumor)

What percentage of testicular tumors develops from germ cells, as opposed to structural (stromal) tissue of the testis?

95 %

If infection affects the testis itself, what is it called?

Orchitis

If a testis atrophies following orchitis, what pathology is the patient at increased risk to develop?

Testicular cancer

Infertility following orchitis is usually accompanied by what physical exam finding?

Bilateral atrophy

If mumps produces orchitis, what is the treatment?

Supportive only

What are the most common causal organisms for epididymitis in an adolescent male?

1. C. trachomatis (most common)

2. N. gonorrhoeae

(E. coli & pseudomonas are also occasional culprits)

How are the Doppler flow studies or radionucleotide scans different for epididymitis/orchitis vs. testicular torsion?

Infection → increased flow & perfusion

Torsion → decreased flow & perfusion

Which two radiological modalities are most preferred for evaluation of the scrotal area?

US and MRI

Is “torsion of the spermatic cord” the same thing as “torsion testis ?”

Yes

In a newborn male, how long should the penis be?

3–4 cm

At what penile length would an endocrine work-up definitely be indicated?

2.5 cm

Should the scrotum have rugae at the time of a full-term birth?

Yes

If one testicle has not descended, how will the scrotal findings at birth be different from usual?

Less rugae

  &

Empty scrotal sac

(on one side)

“Chordee ,” or a ventral curving penis, usually accompanies what minor penile malformation?

Hypospadias

(although chordee often occurs without hypospadias)

What usually is the course for hydroceles present at birth?

Slowly resolves spontaneously

True or false. The foreskin should be retracted on newborns to permit proper cleansing?

False –

It is often adherent & will be damaged by retraction

At what age is it alright to fully retract a foreskin ?

Three years old

If genitalia are ambiguous, and the newborn is otherwise doing well, what is the first consultation/testing type you should pursue?

Genetics –

Figure that out first

Then sort out the endocrine and developmental issues

What is “epispadias ?”

The meatal opening is on the top midline of the penis

(vs. hypospadias, on the bottom)

Is torsion of the testicular appendage painful?

Yes

Is torsion of the testicular appendage a surgical emergency?

No –

No treatment needed other than pain control

What is manual detorsion of a testis?

A usually unsuccessful attempt to correct torsion non-operatively

If one testis is documented to be in torsion, why would surgery be recommended for both testes?

Increased probability of torsion means both should be surgically fixed if one torses

How does testicular torsion present?

Unilateral groin pain/abdominal pain with swelling of the affected testis

+/− nausea/vomiting

What rather unreliable sign of testicular torsion is often mentioned on board exams?

Loss of cremasteric reflex

(testis doesn’t move up when thigh is stroked)

Generally, the pain of testicular torsion should be sudden onset and constant. Why could it also present as intermittent pain?

Sometimes the testis spontaneously detorses, and then torses again, creating intermittent pain

Is a torsed testicle tender to palpation?

Yes

How is torsion of the appendix testis managed?

Supportive care –

Pain meds & anti-inflammatories

Where is the appendix of the testis?

Upper pole

(It is about the size of a pea)

What will a radionuclide scan, or Doppler flow study, show if the problem is torsion of the appendix testis?

Normal or sometimes increased uptake/flow