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Scrotal swellings

Introduction: Understanding scrotal swellings is crucial in urological and general practice. Scrotal swellings can arise from various conditions that may be benign or indicative of more serious pathology. A systematic approach to diagnosis and management is essential.

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.

Assessment Approach:

  • History: Focus on the onset, duration, and associated symptoms (pain, fever, urinary symptoms).
  • Physical Examination: Look for signs of inflammation, palpate the abdomen and scrotum, and perform a transillumination test.
  • Investigations: Ultrasound scrotum is the investigation of choice to differentiate the types of swellings.

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