Surgery

What is epididymo-orchitis?

Acute inflammation of the epididymis and testis, usually from an ascending infection.

What organisms cause epididymo-orchitis in young, sexually active men?

N. gonorrhoeae, C. trachomatis, and coliforms.

What organisms commonly cause epididymo-orchitis in older men and children?

E. coli and other UTI-causing bacteria.

What are typical symptoms of epididymo-orchitis?

• Sudden onset pain

• Unilateral scrotal pain, swelling, and redness

• Dysuria

• Lower urinary tract symptoms

• Fever and systemic illness

• Urethral discharge (in STI cases)

What are typical physical exam findings in epididymo-orchitis?

• Scrotal skin thickening and redness

• Swelling and tenderness

• Firm testis

• Tender prostate on rectal exam (if involved)

What lab tests help diagnose epididymo-orchitis?

• FBC: may show raised WBC

• CRP: may be elevated

• Urea and electrolytes: check renal function

• Blood cultures: if systemic signs are present

What conservative treatments are used in epididymo-orchitis?

• Analgesia: ibuprofen, paracetamol

• Supportive care

What antibiotics are used for STI-related epididymo-orchitis?

Ceftriaxone + doxycycline

What antibiotics are used for enteric (UTI-related) epididymo-orchitis?

Ofloxacin or co-amoxiclav

How does a varicocele usually present?

As a soft, "bag-of-worms" swelling above the testis.

When does a varicocele become more noticeable?

When standing or during a Valsalva maneuver.

What helps distinguish a varicocele from an inguinal hernia or hydrocele?

Lack of cough impulse, absence of transillumination, and irreducibility.

On which side are most varicoceles found?

The left side.

Are varicoceles usually clinically significant?

No, they are common and often not significant.

Who might be affected by a varicocele in terms of fertility?

Younger individuals.

What is a common cause of scrotal swelling?

A hydrocele

What are the two types of hydroceles?

Congenital and acquired.

How can you distinguish a hydrocele from a hernia on exam?

You can usually get above a hydrocele.

What may make it hard to get above a hydrocele?

If the hydrocele is large and extends into the canal.

What does a hydrocele typically feel like?

Smooth and firm due to fluid collection.

Can you usually feel the testicle in a hydrocele?

No, the testicle is often impalpable.

Why is it important to consider the underlying testicle in hydrocele cases?

Because some testicular tumors can present with a hydrocele.

What test can confirm a hydrocele diagnosis?

Ultrasound

Does a hydrocele transilluminate?

Yes, it should transilluminate.

Do small, asymptomatic hydroceles need treatment?

No, they usually don’t need treatment.

When is treatment for a hydrocele needed?

If it causes discomfort.

What is the treatment for a symptomatic hydrocele?

Surgical repair.

What is testicular torsion?

Twisting of the spermatic cord causing venous occlusion, arterial blockage, and testicular ischaemia.

How should acute scrotal pain be treated initially?

As testicular torsion until proven otherwise.

What are typical symptoms of testicular torsion?

Sudden severe testicular pain, lower abdominal pain, nausea, and vomiting.

What might you find on examination of the testis in torsion?

Swollen, tender testis with red scrotal skin.

What is the typical position of the testis in torsion?

High-riding and horizontal (bell-clapper position).

What is Prehn’s sign in testicular torsion?

Lifting the testis doesn’t relieve pain (negative Prehn’s sign), but this is not reliable for diagnosis.

What is the cremasteric reflex and its relevance in testicular torsion?

Stroking the inner thigh causes the testis to rise; it’s usually absent in torsion.

Can the spermatic cord be palpated in testicular torsion?

Sometimes in early cases, but it can be hard in severe swelling.

What is the main treatment for testicular torsion?

Urgent surgical exploration.

What is manual detorsion and when can it be used?

Rotating the testicle outward (like opening a book), used if early or while awaiting surgery.

What surgery is done based on testicle viability in testicular torsion?

Orchidopexy (if viable) or orchidectomy (if not viable), usually done bilaterally.

Where does a direct inguinal hernia occur?

Through a weakness in the posterior wall of the inguinal canal, medial to the deep inguinal ring.

Where does an indirect inguinal hernia occur?

It enters the deep inguinal ring and follows the inguinal canal.

How can you test for an indirect inguinal hernia?

Press over the deep ring (mid-point of inguinal ligament); if the hernia doesn’t reappear after reduction, it's likely indirect.

How can you test for a direct inguinal hernia?

Press over the deep ring; if the hernia still protrudes, it is likely direct, coming through the posterior wall.

How are direct and indirect inguinal hernias treated?

Both are usually treated with mesh repair.

What is a femoral hernia?

A protrusion of abdominopelvic contents through the femoral canal into the upper medial thigh.

How can a femoral hernia appear?

As a lump in the groin, similar to an inguinal hernia.

Where is a femoral hernia located in relation to the pubic tubercle?

Below and lateral to the pubic tubercle.

Where is an inguinal hernia located in relation to the pubic tubercle?

Above and medial to the pubic tubercle.

Are femoral hernias easy to feel?

No, they are often small and hard to palpate, especially in overweight patients.

What imaging can help confirm a femoral hernia?

Ultrasound

How do femoral hernias often present?

As emergencies with bowel obstruction or strangulation.

Should femoral hernias always be repaired?

Yes, due to the high risk of complications.

What is the preferred method of femoral hernia repair?

Laparoscopic mesh repair.