Scrotal disorder

• Scrotum


  An outpouching of the lower part of the anterior abdominal wall that contains the testis, epididymides, and lower end of the spermatic cord

  
• Structure of the spermatic cord


  • Vas deferens
  • Testicular artery
  • Testicular veins (pampiniform plexus)
  • Testicular lymph vessels
  • Autonomic nerves
  • Processus vaginalis
  • Cremasteric artery
  • Artery of the vas deferens
  • Genital branch of the genitofemoral nerve

  
• Types of scrotal swellings


  • Cystic
  • Solid
  • Neither tumor (benign/malignant)
  • Varicocele
  • Hernia
  • Hydrocele
  • Epididymal cyst/spermatocele
  • Haematocele
• Characteristics of scrotal swellings


  • Painful
  • Painless
• Causes of painful scrotal swellings


  • Epididymitis/epididymorchitis
  • Hydrocele
  • Torsion of spermatic cord
  • Inguinoscrotal (total) hernia
  • Torsion of testicular appendages
  • Epididymal cysts/spermatocele
  • Haematocele
  • Varicocele
  • Incarcerated inguinoscrotal hernia
  • Testicular tumors
• Testicular tumors account for 10% of scrotal swellings
• Hydrocele


  A collection of abnormal quantity of serous fluid in the tunica vaginalis. If it contains pus or blood it is called pyocele or haematocele respectively.
• Congenital communicating hydrocele


  Incomplete obliteration of the processus vaginalis allowing fluid collection within tunica vaginalis

  
• Hernia


  A large opening of the processus vaginalis which may allow abdominal contents to enter the scrotal sac
• Causes of hydrocele


  • Primary (cause unknown, associated with patency of processus vaginalis)
  • Secondary (fluid accumulation secondary to pathology inside the testis like epididymo-orchitis, testicular tumor, and trauma)

  
• Symptoms of hydrocele


  • Painless swelling
  • Embarrassment
  • Frequent and painful micturition (if secondary to epididymo-orchitis)
• Hydrocele does not affect fertility
• Examination findings in hydrocele


  • Unilateral or bilateral swelling
  • Normal colour and temperature
  • Primary hydroceles are not tender, but secondary ones may be
  • Fluctuant and have fluid thrill if large enough
  • Cannot be reduced
  • Testis impalpable and transilluminate