Pathophysiology
“Cellulitis of the scrotum”
– Unknown cause
– Hypothesized that it represents a hypersensitivity reaction, similar to angioneurotic oedema
Signs
– May have a small scrotal scratch or insect bite
– Pre-schoolers
– Starts as a small spot, then extends to cover half of the scrotum.
– No testicular tenderness – examine through unaffected skin
Management
– Self resolving
– NSAIDs and antibiotics have been used.
Epididymo-orchitis
Pathophysiology
– Affects very young or very old.
Management
– Infants – exclude urinary tract abnormalities – renal USS + urine culture
– Post pubertal – consider sexual contact
Hydrocele of the cord
This often presents as a “third ball”. For elective management.
Undescended Testes
4% incidence at birth (higher in premature babies), falling to 1% at age 1.
Varicocoele
Thought of as “varicose veins” of the testicular veins.
More common at puberty
Signs
Classically feels like a “bag of worms”.
More commonly on the left, as testicular vein drains into higher-pressured left renal vein with a 90 degree turn
Dullness/ heaviness / scrotal discomfort
Varices more prominent with standing or Valsalva
Does not trans-illuminate
Management
Need to exclude any other causes of obstruction at this level (e.g. renal tumour, renal vein thrombosis) –> especially if happens suddenly
Treat surgically for symptomatic relief
Hydrocele
Happens if there is a patent processus vaginalis.
Signs
Often asymptomatic bilateral scrotal swellings
Sometimes have a blueish discoloration
Transilluminate
Management
Most resolve spontaneously
Surgery if persist beyond 18 – 24 months
If acute, check no inflammatory process
References
And references on testicular torsion page
