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Published byAbraham McKinney
Modified over 4 years ago
Scrotal Lumps Kieran Jefferson UHCW
Current practice 4% of TWW referrals for suspected testicular cancer found to be malignant in recent audit Most commonly epididymal cysts/swellings
History Age Symptoms – pain, dysuria, fever, duration Painful scrotal swelling in a young male is a torsion until proven otherwise
Can you get above the lump? Can you feel the lump separate to the testis? Is it cystic (transilluminate)?
Diagnoses Cannot get above the lump Inguinoscrotal hernia Varicocoele Hydrocoele of the cord Saphena varix
Diagnoses (2) –Separate + Cystic = epididymal cyst –Separate + Solid = epididymitis –Testicular + Cystic = hydrocoele –Testicular + Solid = tumour
Hydrocoele treatment Aspiration – ineffective Surgical plication or excision of sac
Varicocoele treatment High ligation (Palomo) Inguinal ligation Embolisation
Suspected tumour Two-week wait referral Inguinal orchidectomy Staging & oncology referral
Summary If it's not in the testis it's not a tumour If in doubt, refer as TWW
Testis Often difficult to differentiate a serious emergent situation from a more benign situation Pay attention to history, clinical picture and pain expression.
Dedifferentiated Paratesticular Myxoid Liposarcoma :
History 19-year-old male with acute right scrotal pain for the last 5 hours No fever, dysuria, nausea and vomiting No previous pain episodes No history.
Author(s): Gary Faerber, M.D., 2011
Non Acute Scrotal Swelling
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