Download - Scrotal Masses and Testis Tumours
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Scrotal Masses
UBC Department of Urologic Sciences Lecture Series
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Disclaimer:
• This is a lot of information to
cover and we are unlikely to coverit all today
• These slides are to be utilized for
your reference to guide your selfstudy
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MCC Objectives
http:mcc!cae"aminationsobjectives#overview
$or %MCC &art 'Objectives applicable to this lecture:
– (crotal Mass )*+#+,
– (crotal &ain )*'#+,
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Objectives
(crotal Mass:'! -iven a patient with a scrotal mass:
'! To list and interpret key clinical .ndings/! To list and interpret critical investigations
0! Construct an initial management planCausal Conditions:
• 1ydrocele• 2aricocele• 1ematocele hematoma
• Testis malignancy• 3n4ammatory 3nfectious
/! 5ecognize testicular torsion
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Approach to Scrotal Mass
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Approach to Scrotal Mass
PAINFUL•Epididymitis•Orchitis
• Hydrocele• Varicocele• Spermatocele• Torsio o! Testis• Torsio o! Appedi" Testis
• Testis T#mor
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Approach to Scrotal Mass
• History – Pai$ oset$ !irmess$ h" o! #desceded testis$ ST%&s$
LUTs$ #rethral dischar'e
• Physical E"am – Locatio o! mass (testis$ epididymis$ scrot#m) – Tederess – Trasill#miace
• I*esti'atios – U+A – py#ria ,ith epididymitis + orchitis – U+S – -- Sesiti*e ad speci!ic !or testic#lar t#mors
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I!ectio#s Scrotal Mass
Epididymitis
– .o#' ad#lts
• o!te associated ,ith STI$ chlamydia
– Older ad#lts
• o!te o/STI$ E 0oli1
– Teder$ id#rated epididymis
• Orchitis – May 2e ca#sed 2y M#mps *ir#s
– S,olle -- teder testicles$ o!te 2ilateral
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Aatomic Scrotal Mass3 Hydrocele
• Hydrocele• Fl#id ,ithi t#ica *a'ialis• 0alled 4comm#icati'
hydrocoele5 i! processus
vaginalis is patetHistory
• Typically pailess
Physical E"am• Trasill#miates
• 0aot palpate testicleTreatmet• No 6" re7#ired #less !or
cosmetic reasos or2othersome si8e
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Aatomic Scrotal Mass
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Aatomical Scrotal Mass3 Spermatocele
Spermatocele
• 0ystic dilatatio (ae#rysm)o! epididymal t#2#le
History• Pailess
Physical E"am• Trasill#miates
• 0a palpate 2ody o! testicleseparate !rom the mass
Treatmet• No treatmet re7#ired #less
!or cosmetic reasos
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Aatomical Scrotal Mass3 Varicocele
• Varicocele
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Aatomical Scrotal Mass3 Varicocele
• Varicocele
– Varicosities o! pampii!orm ple"#s• 9:; o le!t side< see i =>; o! male pop#latio• Associated ,ith male !actor i!ertility 2#t most me ,ith
*aricocoeles ca e"pect ormal !ertilityHistory
• Typically asymptomatic$ cosmetically 42a' o! ,orms5• Icreases i si8e ,ith *alsal*a or stadi' positio
Physical E"am• ?a' o! Spa'hetti i scrot#m palpati' cord
Treatmet• S#r'ical or a'io'raphic sclerosis
– 6es#lts i impro*emet i seme parameters (#m2er$motility$ morpholo'y) i @:; to 9:; o! cases
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Aatomical3 The Ac#te Scrot#m
• Testic#lar torsio
– S#r'ical Emer'ecy
– Oly de!iiti*e %ia'osis is S#r'ical Scrotal
E"ploratio
– Typically i =B/=Cyr olds
– D hr ,ido, prior to irre*ersi2le testic#lar
ischemia – Associated ,ith ?ell 0lapper %e!ormity5
– %etort – 4lie opei' a 2oo5
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Aatomic Scrotal Mass3 The Ac#te Scrot#m
• Testic#lar Torsio
Physical E"am• Hi'h ridi'$ hori8otal testicle
• A2set cremasteric re!le"• Preh Si'3 relie! o! pai ,he s#pporti' the scrot#m
– s#''ests epidiymitis
I*esti'atios• U+A – 6+O py#ria (epidiymitis)
• %oppler U+S oly i! dia'osis #clear
Treatmet• S#r'ical detorsio ad orchidope"y
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Ac#te Scrot#m
• Epididymitis – I!ectio o! the epididymis
• G>yrs o! a'e – 0hlamydia$ 'oorrhea• >yrs o! a'e – E1 0oli
History• Pai$ S,elli' testicle -+/ dys#ria -+/ !e*er
Physical E"am• Id#rated$ s,olle ad ac#tely pai!#l epididymis$ -+/ erythema
I*esti'atios• 0?0• U+A• -+/ %oppler US o! testis
Treatmet• Ati2iotics "J ,ees - NSAI%S$ ad Ice P6N
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Epididymitis
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Ac#te Scrot#m3 Torsio o! Appedi" Testis
Torsed Appedi" testis – May mimic Testic#lar Torsio
Physical E"am – ?l#e %ot si' –
Testis may 2e i!lamed+teder$ poittederess to appedi" testis – Not liely ele*ated$ NO hori8otal lie
I*esti'atios – %oppler US to assess testis per!#sio – U+A
Treatmet – 0oser*ati*e$ symptom maa'emet i!
co!irmed – Urolo'ical assessmet1
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Approach to Scrotal Mass
PAINFUL•Epididymitis•Orchitis
• Hydrocele• Varicocele• Spermatocele• Torsio o! Testis• Torsio o! Appedi" Testis
• Testis T#mor
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Testic#lar 0acer
• Typically occ#rs i
yo#' healthy Me1
• Very 'ood c#re
rates E*e !orMetastatic %isease
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Testic#lar 0acer
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Testic#lar 0acer
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Testic#lar 0acer
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Testic#lar 0acer
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Secodary Testic#lar 0acer
• Lymphoma
• Le#emia
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Testic#lar 0acer
• Presetatio
– Typically pailess itratestic#lar mass
disco*ered o sel! e"amiatio
– A'e =>/>
• Al2eit some t#mor s#2ytpes cl#ster i i!acy ad
some at later a'e (D:&s)
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Testic#lar 0acer
• I*esti'atios – La2s
• ?/H0K – Prod#ced 2y choriocarcioma i some Semiomas
• Alpha/!etoprotei – Prod#ced 2y .ol Sac$ Em2ryoal 0arcioma Teratocarcioma
• L%H – 0orrelates ,ith t#mor *ol#me
– Ima'i'
• Scrotal U+S• 0T A2do ad Pel*is3 assess !or retroperitoeal mets
• 06
• -+/ 0T Head
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AK B::B U?0 Phase IV Urolo'y
Sta'i'
Lar'e retroperitoeal
mass i patiet ,ith
ri'ht testic#lar
NSK0T
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Lymphatic Spread3 6PLN%
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AK B::B U?0 Phase IV Urolo'y
#estio Q=
• J ca#ses o! scrotal masses or s,elli's
that are pailess
• ca#ses o! ac#tely pai!#l testicle
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AK B::B U?0 Phase IV Urolo'y
%i!!eretial %ia'osis o! a Scrotal Mass
• hydrocoele• spermatocoele• *aricocoele
• testic#lar cacer
• epididymitis
• testic#lar torsio• torsio o! the testic#lar appedi"
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AK B::B U?0 Phase IV Urolo'y
Ac#tely Pai!#l Scrot#m
I adolescets ad yo#' me$ ,ith o history o! tra#ma$
the possi2ilities icl#de3
/ Testic#lar Torsio
/ Epididymitis
/ Torsio o! the Appedi" Testis
Testic#lar torsio ad torsio o! the appedi" testis aree"tremely #commo i older me
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AK B::B U?0 Phase IV Urolo'y
#estio QB
Lace Armstro' has oticed a 4s,elli'5 i
his remaii' testicle1
hat !eat#res o history or physical e"am
s#''est a testic#lar cacerR
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AK B::B U?0 Phase IV Urolo'y
Testic#lar cacer
• A'e => – > yrs
• History o! cryptorchidism or pre*io#s testic#lar
cacer
• Pailess• %oes ot trasill#miate
• Feels hard ad irre'#lar
• 0ostit#tioal symptoms (,ei'ht loss)
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AK B::B U?0 Phase IV Urolo'y
Sel! / E"amiatio
Sel! – e"amiatio sho#ld
2e ta#'ht to yo#' me
They eed to 2e sho,the di!!erece 2et,ee the
testicle ad the epididymis
They eed to report ayhard or s#spicio#s lesios
immediately