inguino-scrotal swelling. bilateral inguinal hernia most common ( young, rt. side ) most common (...

INGUINO-SCROTAL INGUINO-SCROTAL SWELLINGSWELLING

Bilateral Inguinal herniaBilateral Inguinal hernia most common ( young , most common ( young ,

Rt. Side )Rt. Side ) Hernia in babies are a Hernia in babies are a

result of persistent patent result of persistent patent processus vaginalis.processus vaginalis.

If strangulated >> painful If strangulated >> painful and may cause testicular and may cause testicular atrophyatrophy

Surgery is usually Surgery is usually recommended .(by high recommended .(by high ligation) as early as ligation) as early as possible.possible.

NB: NB: my observation -my observation - Alyaa Alyaa cryptorchidism ---cryptorchidism --- repair repair at one yearat one year of of

age cuz most of them reduce spontaneously age cuz most of them reduce spontaneously by age of one. by age of one.

congenital hydrocele ( primary , congenital hydrocele ( primary , communicating ) ---communicating ) --- repair repair at two years at two years of of age for the same above reason.age for the same above reason.

ButBut

Indirect inguinal hernias in peads r better Indirect inguinal hernias in peads r better repaired as early as possible.repaired as early as possible.

HydroceleHydrocele

1-primary(congenital , communicating)1-primary(congenital , communicating)Common in pediatricsCommon in pediatrics

associated with patency of proccessus vaginalisassociated with patency of proccessus vaginalismost neonatal hydrocele resolve in first 2 year of most neonatal hydrocele resolve in first 2 year of

life if persists repair as herniotomy.life if persists repair as herniotomy.

2-secondary ( non-communicating ) ; 2-secondary ( non-communicating ) ; to to pathology inside the testis like epididymo-pathology inside the testis like epididymo-orchitis,testicular tumor and traumaorchitis,testicular tumor and trauma

DxDx: painless : painless swellingswelling

Testis impalpable and transillumenateTestis impalpable and transillumenate

Unilateral UDTUnilateral UDT

UDT=undescended testis = cryptorchidismUDT=undescended testis = cryptorchidism

We describe the picture as left hypoplastic We describe the picture as left hypoplastic scrotum ( empty scrotum ) with scrotum ( empty scrotum ) with undescended testis.undescended testis.

Bilateral UDTBilateral UDT

Intra-abdominal TestisIntra-abdominal Testis

-empty scrotym(-empty scrotym(mostlymostlyhypoplastic scrotum ):hypoplastic scrotum ):

-types:-types:

1-1-truetrue: can not be brought: can not be brought

Down, palpable mostly in the course of Down, palpable mostly in the course of inguinal canal & hopoplastic scrotum.inguinal canal & hopoplastic scrotum.

2-2-ectopicectopic: same as true but not in the : same as true but not in the course of the inguinal canal & hypoplastic course of the inguinal canal & hypoplastic scrotum.scrotum.

3-3-retractileretractile: due to cremasteric reflux, : due to cremasteric reflux, scrotum scrotum not hypoplastic not hypoplastic & testes can be & testes can be brought down.brought down.

Indication of surgery:Indication of surgery:

1- torsion1- torsion

2-trauma2-trauma

3-tumor (it is an imp risk)3-tumor (it is an imp risk)

4-infertility4-infertility

5-cosmetic5-cosmetic

Rx: nothing done before 1 y Rx: nothing done before 1 y

( orchidopexy )( orchidopexy )

Laproscopy is Dx & RxLaproscopy is Dx & Rx

Acute scrotumAcute scrotum

Gangrenous TestisGangrenous Testis

Gangrenous TestisGangrenous Testis

DDx of acute painful scrotal swelling:DDx of acute painful scrotal swelling:

Torsion of testis or appendagesTorsion of testis or appendages

TraumaTrauma

Infection/inflammationInfection/inflammation

Hernia (incarcerated) Hernia (incarcerated)

Torsion of testisTorsion of testis•Sudden onset of severe pain in the scrotum and Sudden onset of severe pain in the scrotum and groin and radiating to the lower abdomen groin and radiating to the lower abdomen associated with vomiting.associated with vomiting.•Swollen, painful, testis drawn up to the groin.Swollen, painful, testis drawn up to the groin.

Rx: EMERGANCYRx: EMERGANCY Explore the testis.Explore the testis. Untwist the testis.Untwist the testis. If viable so fix to scrotum by anchoring it to If viable so fix to scrotum by anchoring it to

scrotal septum and if the other testis is abnormal scrotal septum and if the other testis is abnormal fix it.fix it.

If infracted so remove itIf infracted so remove it

Torsion of testicular appendage:Torsion of testicular appendage:

-Usually a more gradual -Usually a more gradual onset, pain moderately onset, pain moderately severesevere

-Blue dot sign-Blue dot sign

-If dx is in question, -If dx is in question, surgical explorationsurgical exploration

-Rx ; immediate -Rx ; immediate operation with ligation operation with ligation and amputation of the and amputation of the twisted appendage.twisted appendage.

Epididymal cystEpididymal cyst

• Usually smooth and Usually smooth and lobulated, fluctuant, lobulated, fluctuant, transilluminates if contains transilluminates if contains clear fliud.clear fliud.

Rx : none unless large, so Rx : none unless large, so surgical excision, and that surgical excision, and that will compromise the will compromise the fertility of the testis.fertility of the testis.

Idiopathic scrotal edemaIdiopathic scrotal edema

Sudden onset, unilateral or bilateralMinimal tendernessNormal gonadsSelf limiting process

conservative treatment

Testicular cancerTesticular cancer The commonest malignancy in The commonest malignancy in

young men.young men. 90% arise from germ cells and 90% arise from germ cells and

are either seminomas or are either seminomas or teratomas.teratomas.

10% are lymphomas, sertoli cell 10% are lymphomas, sertoli cell tumours or leyding cell tumours.tumours or leyding cell tumours.

Imperfectly descended testes Imperfectly descended testes have a 20-30 times increase risk have a 20-30 times increase risk

of malignancyof malignancy.. Rx & classification impRx & classification imp

Germ cell tumerGerm cell tumer SeminomaSeminoma Spermatocytic seminomaSpermatocytic seminoma Embryonal carcinomaEmbryonal carcinoma Yolk sac tumourYolk sac tumour Trophoblastic tumourTrophoblastic tumour TeratomaTeratoma Dermoid cyst, , Epidermoid cyst

• Sex cord/Gonadal stromal tumoursSex cord/Gonadal stromal tumours• Leyding cell tumourLeyding cell tumour• Sertoli cell tumourSertoli cell tumour• Granulosa cell tumourGranulosa cell tumour

• Mixed Germ Cell and Sex Cord/Gonadal Stromal TumoursMixed Germ Cell and Sex Cord/Gonadal Stromal Tumours

• gonadoblastomagonadoblastoma

- imp:- imp:Tumour markers: AFP, Tumour markers: AFP, ββHCG, LDHHCG, LDH

RX: ( imp)RX: ( imp) OrchidectomyOrchidectomy• If metastasized :If metastasized :

1.1. If seminoma: Radiotherapy plus If seminoma: Radiotherapy plus chemotherapy.chemotherapy.

2.2. If teratoma: combination chemotherpay If teratoma: combination chemotherpay 33 drugs(etoposide, vinblastine, methotrexate, drugs(etoposide, vinblastine, methotrexate, bleomycin, cisplastin)bleomycin, cisplastin)

No radiotherapy for teratomaNo radiotherapy for teratoma