1. Dr. Teo Zue Hiong

2. Content
 Hydrocele
 Hematocele
 Spermatocele & eppidydymal cyst
 Varicocele
 Testicular tumor
 Testic torsion
 Epidydymo-orchitis
Undescended testis

6. hydrocele
 Excessive collection of fluid within tunica
vaginalis
 Divided into congenital & acquired
(further divided into primary and
secondary )

7.  Congenital
 -patent connection with peritoneal cavity via patent
processus vaginalis
 Acquired
Primary:
-Idiopathic
-Can reach very large size with no pain
Secondary:
-Trauma/infection/tumor
-Small size. Tender if underlying testis tender

8. PE
 Usually bilateral
 Translucent
 Testis impalpable

9. complication
 Rupture
 Hematocele
 Infection
 Hernia of hydrocele sac
 Sac wall calcification
 Testic atrophic

11. hamatocele
 Collection of blood within tunica
vaginalis
 Due to trauma or underlying malifnant
 Not translucent (distinguished from
hydrocele)

12. varicocele
 Dilated, tortuous & elongated veins of
pampiniform plexus of spermatid vein
(varicose vein in spermatid cord)
 90% on the left because Lt testicular vein drain
into high pressure renal vein where the Rt
testicular vein drains directly into IVC
 Usually asymptomatic but pt usually infertile as
it increases scrotal temperature which affect
normal sperm function

14. Spermatocele & epididymal cyst
 Testis are palpable
 Cant distinguished clinical. Only by
aspiration.
-Spermatocele: slightly grey, opaque fluid
containing spermatozoa
-Epidydymal cyst: clear fluid

15. Testicular tumor
 20-40 years old
 >90% are derived from germ cells
 Most common
-Seminomas: derived from spermatocyte
-Teratoma: dereved from 3 germ cell layer
ectoderm/mesoderm/endoderm

16. Presentation
-solid testicular lump
- painless
- may cause secondary hydrocele

17. spread
 Spread to para-aortic LN > thoracic duct
> supraclavicular LN
 Inguinal LN are not involved unless
spread to scrotal skin

18. Investigation
 USG for scrotal content
 Chest X-ray for lung secondaries
 Tumour marker
o B-HCG
o AFP
o LDH
 CT for staging

19. staging
 I: confined to testis
 II: retroperitoneal LN
 III: metastasis above diaphragm
confined to LN
 IV: extralymphatic metastasis

20. treatment
 orchidectomy
 Radiotherapy
 Chemotherapy
 LN dissection

21. Acute epidydymo- orchitis
 Primarily an infection of the epididymis
but then spread into testis
 Organism : chlamydia/gonococcus/
E.coli
 May be assoc with UTI

22. Presentation
 Acute severe testicular pain
 Pain is decrease by raising the testis
 Scrotal skin red, hot & edematous

24. Aetiology and pathological
features
 Rare,except a/w mumps
 Blood-borne infection
 Surgical procedure on the lower urinary
tract,e.g. TUR
 Organism: Neisseria gonorrhoeae,
Escherichia coli and Chlamydia. In young man,
the commonest is Chlamydia
 Tuberculosis

25. Clinical features
 Preceding Hx of an operation or of
dysuria, frequency and heamaturia
 Acute pain in scrotum,swelling
 Epididymis:acutely tender and
enlarged(although it maybe difficult to
differentiate from the equally tender
testis)
 Overlying redness and oedema maybe
present

26. Investigation
 FBC: leucocytosis
 Blood culture: helpful to direct antibiotic
treatment
 Urinalysis: pyuria, organism maybe
revealed by culture
 Aspiration of the epididymis
 USG: increased blood flow

27. Management
 Bed rest,scrotal elevation
 Tetracycline or erthromycin
 Other antiobiotic refer to culture
 Partner should also be investigated and
treated

29. Epidemiology
 Both testes are undescend in 30% of
premature infants
 Term:3%
 One year:1%
 Spontaneous descent after one year is
rare

30. Aetiology
 Failure of migration along the normal
line of descent
 Ectopic testis:testicle deviates away
from the line and lie in front of the penis
in the superficial inguinal pouch,in the
perineum or in the thigh.(reason
unknown)

31. Risk factor
 Prematurity
 Low birth weight
 Twin gestation
 Down syndrome(fetus) or other chromosomal
abnormality
 Gestational diabetes mellitus
 Prenatal alcohol exposure
 Hormonal abnormalities (fetus)
 Toxic exposures in the mother
 Mother younger than 20
 A family history of undescended testes

32. Clinical features
An empty scrotal sac or hemiscrotum at 1 year
indicates:
 Proximal to the external inguinal
ring(undescended)
 Truly absent
 Retractile-the cremaster muscle reflexly pulls the
organ up towards the inguinal canal
 Ectopic

33. Complication
 Infertility:inevitable in bilateral and
common in unilateral
undescent,frequent in those who are
undescent treated.
 Torsion
 Trauma
 Inguinal hernia
 Malignant disease

34. Investigation
 USG,CT and laparoscopy
Management
 Target is to bring the testicle with its blood supply
into the scrotum as early as possible
 Orchidopexy:should be done beyong puberty
 Testicular prosthesis can be placed in the
scrotum

35. 1 Epididymis
2 Head of epididymis
3 Lobules of epididymis
4 Body of epididymis
5 Tail of epididymis
6 Duct of epididymis
7 Deferent duct (ductus deferens or vas
deferens)

36. Testicular torsion
 Testicular torsion occurs when the spermatic
cord(from which the testicle is suspended)
twists, cutting off the testicle's blood
supply(ischemia)
 Cause: recognised complication of testicular
maldescent wherein the testis is inadequately
affixed to the scrotum allowing it to move freely
on its axis and susceptible to induced twisting of
the cord and its vessels.
 Occurs most probably between birth and early
adolescence

37. Twist VS Untwist
 Twist deprives the organ of its blood
supply
 If untwist does not take place within 6
hours,ischaemia is irreversible,gangrene
develops and the testis either
suppurates or atrophies

38. Presentation & Finding
 Acute severe testicular pain(affected side)
 Testis is tender,swollen and hang higher
up(compared to other side)
 Poorly localized central abdo pain
 Vomitting(sometimes)
 Scrotal skin become red,hot and edematous in
later stage
 Palpation may feel the twisted cord
Pain is increase or no improvement by raising the
testis

39. Investigation
 Urinalysis:sterile,acellular urine
 USG:absence of blood supply to the
affected testicle

40. Management
 Surgical emergency
 Non-operative
Maybe possible to de-rotate the testis
 Surgical
Failure of non-operative reduction require
emergency operation
The testis is de-rotated and fixed
The gangrenous testis is removed

41. Dignosis of lumps in the scrotum
1. Can u get above it? : if not, mostlikely is an
inguinoscrotal hernia.(or a hydrocele extending
proximally)
2. Is it separate from the testis?
3. Is it cystic or solid?
 Separate and cystic - epididymal cyst or
spermatocele
 Separate and solid - epididymitis (may also
orchitis)
 Testicular and cystic – hydrocele
 Testicular and solid – tumour, orchitis