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Friday 8 May 2015

Non Torsion Scrotum

Idiopathic Scrotal Oedema
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
http://radiopaedia.org/articles/acute-idiopathic-scrotal-oedema-1
http://learning.bmj.com/learning/module-intro/children-urogenital-conditions.html?moduleId=10042266&searchTerm=%E2%80%9Cscrotum%E2%80%9D&page=1&locale=en_GB
http://learning.bmj.com/learning/module-intro/children-abdominal-conditions.html?moduleId=10042263&locale=en_GB
http://wikem.org/wiki/Varicocele
http://wikem.org/wiki/Hydrocele
And references on testicular torsion page
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