Scrotal swellings

Hydrocele:

• Definition: An accumulation of serous fluid within the tunica vaginalis, surrounding the testicle.
• Etiology: Can be idiopathic, congenital, or secondary to trauma, infection, or tumours.
• Clinical features: Painless, smooth, and cystic swelling that can transilluminate light.
• Management: Asymptomatic hydroceles may not require treatment. Surgical intervention (hydrocelectomy) is indicated for symptomatic cases.

Epididymal Cysts:

• Definition: Benign cysts that arise from the epididymis.
• Clinical features: Painless, discrete, and spherical swellings that may also transilluminate.
• Management: Observation is typically sufficient. Surgery is rarely needed unless the cyst is causing discomfort or is particularly large.

Varicocele:

• Definition: An enlargement of the veins within the scrotum, akin to varicose veins.
• Etiology: Often idiopathic due to incompetent valves within the spermatic cord veins.
• Clinical features: Described as a “bag of worms” feeling, often asymptomatic but can cause a dull, aching pain.
• Management: Conservative management includes scrotal support or analgesia. Surgical treatment is considered if there is pain, infertility, or testicular atrophy.

Mumps Orchitis:

• Etiology: A viral infection usually associated with parotitis, can spread and cause inflammation of the testes.
• Clinical features: Testicular pain, erythema, and swelling occurring 4-7 days after parotitis.
• Management: Supportive care, including rest, ice, analgesia, and sometimes hospital admission for severe cases.

Testicular Torsion:

• Definition: A urological emergency where the spermatic cord twists, cutting off the testicle’s blood supply.
• Clinical features: Sudden, severe testicular pain, nausea, vomiting, and scrotal swelling. The “cremasteric reflex” is often absent.
• Management: Immediate surgical exploration and detorsion are necessary to save the testicle.

Inguinal Hernia:

• Definition: Protrusion of abdominal contents through the inguinal canal into the scrotum.
• Clinical features: A swelling that may increase with coughing or straining and can often be reduced manually.
• Management: Surgical repair is indicated to prevent complications like strangulation.