Surg : diseases of the testis and scrotum

what is epididymitis

Inflammation/infection of epididmitis

epididimitis vs torsion symptoms in adolescents

more gradual onset of pain

what are the causes of epididymitis

STDs, trauma, vasectomy, UTI.

epididymitis sympotms

Pain, swelling, nausea, fever, urinary symptoms.

what is orchitis

inflamation of the testis

mumps orchitis

20-30% cases with mumps , mostly unilateral, post-puberty infertility risk ↑ if bilateral.

when does mumps orchitis present in mumps pt

4-6 days after mumps parotitis

causes of orchitis

Post-epididymitis, viral (mumps, coxsackie), bacterial (brucellosis).

causes of testicular pain other than orchitis

inguinal hernia , HSP (vascultis)

can there be referred pain in testits

yes if retrocecal appendix and urolithiasis

truama of testis and trauma and managment

result of Compression against pubis → rupture of tunica albuginea/vaginalis → hematocele/scrotal hematoma.

what inv can be done to asses testicular trauma

Doppler and surgery if uncertain

Idiopathic Scrotal Oedema

in Boys <10 yrs causing mild pain, redness, oedema; testis normal.

Idiopathic Scrotal Oedema ttt

Antihistamines, anti-inflammatories; resolves in days

Idiopathic Scrotal Gangrene (Fournier's)

Fulminant necrotising infection (polymicrobial: strep, staph, E. coli, clostridia).

Idiopathic Scrotal Gangrene (Fournier's) features

Sudden pain, swelling, necrosis of skin, testes spared

Idiopathic Scrotal Gangrene (Fournier's) ttt

Aggressive debridement + broad antibiotics; high mortality

Hydrocele

Fluid in tunica vaginalis.

1r vs 2ry hydrocele

Primary : Slow onset, >40 yrs, painless, large.

Secondary : Rapid onset, due to infection, trauma, tumour; painful, smaller.

hydrocele signs

Cystic, transilluminates, can get above swelling, testis not separately palpable.

hydrocele complications

Rupture, infection, hematocele, calcification, hernia, atrophy.

hydrocele types

Congenital, vaginal, infantile, cord hydrocele, canal of Nuck (females).

hydrocele ttt

Jaboulay's eversion, Lord's plication.

spermatocele

Painless, cystic swelling containing sperm, separate from testis, transilluminates.

spermatocele effect on fertility and ttt

No effect on fertility

surgery only if painful

testicular torsion and peak age

Twisting of spermatic cord → ischemia.

Peak: 10-20 yrs.

testicular torsion associations

1. Imperfectly descended testis

2. High investment of tunica vaginalis with a horizontal lie of testis 3. Epididymis& testis are separated by a mesorchium, & twisting occurs at the mesorchium

causes of torsion testis

Abnormal fixation (bell-clapper deformity), high tunica vaginalis investment, undescended testis.

neonatal vs pubertal torsion testis

Neonatal (extravaginal) : Often prenatal; testis necrotic; orchiectomy + contralateral orchiopexy.

Pubertal (intravaginal) : Sudden severe pain, transverse lie, absent cremasteric reflex, secondary hydrocele possible.

ttt of torsion testis

Urgent surgery within 6 hrs; orchiopexy if viable, orchiectomy if not.

appendix tesis torsion

Prepubertal, mild pain, blue-dot sign, preserved cremasteric reflex; conservative management.

varicocele

Dilated pampiniform plexus veins; 90% left-sided due to drainage into renal vein.

"Bag of worms" feel; worse on standing/valsalva; may cause infertility

varicocele is more common on the …… side

left as it drain in high pressure renal vein

what to rule out in varicocele

Rule out IVC obstruction if right-sided, prepubertal, or non-reducible lying down.

varicocele ttt

Usually conservative; surgery if testis volume affected.

Cryptorchidism and ttt

Failure of testis to descend; normal descent: T10-T12 origin → scrotum by 9th month gestation.

Orchidopexy if not descended by 1 yr to reduce infertility/malignancy risk.

Lymphatic Drainage of Testis

To para-aortic & interaortocaval nodes (L1-L3); scrotal skin drains to inguinal nodes