DIFFERENCIAL

S TO SCROTAL
SWELLING

PRESENTER: DR SINKALA YIZUKANJI

OUTLINE
• ANATOMY OF THE SCROTM
• PAINFUL SCROTAL SWELLING CONDITIONS
• PAINLESS SCROTAL SWELLING CONDITIONS
• SCROTAL EXAM
• GENERAL INVESTIGAIONS
ANATOMY OF THE SCROTUM-
LAYERS
TESTES
ARTERIES
VEINS
NERVES
LYMPHATICS
SCROTAL SWELLING
DIFFERENTIALS- PAINFUL
• Usually acute and includes the following:-
1. Testicular torsion
2. Acute epididymorchits
3. Torsion of testicular appendix
4. Traumatic haematoma
5. Strangulated inguinal hernia
6. Thrombosis of spermatic vein
Testicular torsion
• Acute onset severe scrotal pain aggravated by activity.
• May be associated with nausea and vomiting.
• Teenagers and young adults.
• Twisting of the spermatic cord with blood supply compromise.
• Detorsion and bilateral orchidopexy if testes is viable
• Orchidectomy and orchidopexy of the remaining testes is done is
testes is non viable
Torsion of appendix of testes
• Acute swelling and pain that is progressive and usually occurring
during rest.
• Pain can be severe but nausea and vomiting are less common.
• Occur as a result of torsion of the appendix of the testes causing
swelling an inflammation of both the testes and epididymis resulting
in pain and erythema of the scrotum
Epididymo-0rchitis
• Follows or occurs with a UTI or trauma
• Acute or protracted pain
• Associated with dysuria, fever and pyuria.
• Positive Prehn's test
• Urine M/C/S
• Analgesia and antibiotics
Traumatic haematoma
• Acute swelling and pain following blunt force trauma to the testes.
• A collection of blood within the scrotum
• May complicate to epididymo-orchitis.
• Self resolving but my require drainage if too big.
• analgesia
Strangulated hernia
• Previous diagnosis of hernia
• Becoming trapped and irreducible compromising blood supply
• Severe pain
• Nausea and vomiting
• Fever
• May complicate to perforation and peritonitis
• Give strong analgesia like pethidine to allow patient to relax before
attempting manual reduction.
• Exploratory laparotomy if reduction is not possible.
SCROTAL SWELLING
DIFFERENTIALS- PAINLESS
• Tumours
• Hydrocoele
• Hernia
• Varicocele
• Spermatocele
• Sebaceous cyst
Testicular Tumours - Benign
1. Leydig cell tumours:- most common(75% of benign). Occurs in middle aged men
and associated with hormonal imbalance due to production of androgens.
2. Sertoli cell tumours:- less common than Leydig cell and typically occurs in older
men. Can be associated with gynaecomastia.
3. Epidermoid cyst:- keratin debris typically occurs in young men and a source of
discomfort.
4. Dermoid cyst:- skin and other tissues
5. Adenomatoid tumours: very rare and occurs in older men
They are painless and slow growing.
Diagnosis by histology.
Testes sparing orchiectomy is the treatment
Testicular Tumours - Malignant
1. Germ cell Tumours:- most
common (30-40%).
• Seminomas 30 to 40% 0f cases
and 60-70% non seminomas.
• Examples include:- embryonal
carcinoma, Yolk sac tumour,
choriocarcinoma and teratomas.
2. lymphomas:- very rare and occurs in older men
3. Metastatic tumours:- very rare
treatment of malignant disease of the testes include, chemotherapy,
radiotherapy and surgery.
surgical options( orchiectomy)
• Radical orchiectomy:- removal of testes, spermatic cord and n lymph nodes.
• Simple orchiectomy:- removal of testicle only.
• Testicular sparing orchiectomy: preservation of as much testicular tissue as
possible
Hydrocele
• Fluid collection within the tunica vaginalis[parietal and visceral
surfaces).
• Causes: incomplete closure of processus vaginalis in infants
• Scrotal injury, infections, STIs, tumours.
• Positive transillumination test.
• Treatment: watchful waiting in infants, needle aspiration. And
hydrocelectomy.
Inguinoscrotal hernia
• Protrusion of intestines through the inguinal canal into the scrotum.
• Surgical treatment:- herniorrhaphy, hernioplasty and herniotomy.
• Can become strangulated.
varicocele
• The dilatation of the pampiniform plexus of veins that drain the
testes.
• Present with infertility
• Palpable dilated tortuous veins within the scrotum, described as a bag
full of worms.
• Surgery: varicocelectomy, varicose vein ligation, embolization.
• Assisted reproductive tecniques.
Spermatocele
• A benign cystic accumulation of sperm that arises from the head of
the epididymis
others
• Sebaceous cyst
• Fluid filled cyst within the skin of the scrotum. Sebaceous gland of origin
• elephantiasis
SCROTAL EXAM
• Do a full genital exam
• Inspection:- size, overlying skin, previous scars,
• Palpation:- texture, surface, solid, fluctuant, cystic with
transillumination, tenderness. Cremasteric reflex, prehn’s sign.
• Palpate also the inguinal nodes.
• Examine the abdomen also
INVESTIGATIONS
• Urinalysis • Biopsy of solid tumours
• Urine M/C/S • FNAC of tumour and lymph node
for cytology.
• Testicular U/S
• CT for staging of carcinomatous
• Doppler U/S conditions
• Abdominal U/S • Tumour makers
• FBC/DC • B- HCG
• AFP
• LHD
 O U
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