scrotal masses and testis tumours

8/17/2019 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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PAINFUL•Epididymitis•Orchitis

• Hydrocele• Varicocele• Spermatocele• Torsio o! Testis• Torsio o! Appedi" Testis

• Testis T#mor


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• 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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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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#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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%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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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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#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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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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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

scrotal masses and testis tumours

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