"Cellulitis of the scrotum"
- Unknown cause
- Hypothesized that it represents a hypersensitivity reaction, similar to angioneurotic oedema
- May have a small scrotal scratch or insect bite
- Starts as a small spot, then extends to cover half of the scrotum.
- No testicular tenderness - examine through unaffected skin
- Self resolving
- NSAIDs and antibiotics have been used.
- Affects very young or very old.
- 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.
4% incidence at birth (higher in premature babies), falling to 1% at age 1.
Thought of as “varicose veins” of the testicular veins.
More common at puberty
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
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
Happens if there is a patent processus vaginalis.
Often asymptomatic bilateral scrotal swellings
Sometimes have a blueish discoloration
Most resolve spontaneously
Surgery if persist beyond 18 - 24 months
If acute, check no inflammatory process
And references on testicular torsion page