Scrotal Pain & Swelling

Scrotal Pain & Swelling

Assumptions

The student knows the anatomy of the scrotal contents. The student is familiar with the embryologic

development and descent of the testicle.

Objectives

1. Generate a list of potential diagnoses for the patient who presents with pain or a mass in the scrotum.

·  Discuss testicular vs. extratesticular origins

·  Discuss benign vs. malignant causes

·  Discuss emergent vs. nonemergent causes

2. List history and physical exam findings that will help you differentiate etiologies. Be sure to discuss the

following issues:

·  pain - presence, absence, onset, severity

·  palpation - distinguish testicular from extratesticular (adnexal) mass

·  effect of Valsalva maneuver

·  transillumination

3. Discuss the diagnostic algorithm for scrotal swelling and/or pain.

4. Discuss the staging and treatment of testicular cancer.

5. Discuss treatment of non-malignant causes of scrotal swelling and/or pain.

6. Discuss diagnosis and treatment of the undescended testicle (be sure to consider age of diagnosis).

Problem

1. A 35-year-old man presents with a new mass in his left hemiscrotum.

·  What findings on history and physical exam would help you to determine if this is a mass in the testicle?

·  What lab tests would you order if there is a mass in the testicle?

·  If you think the mass is malignant what diagnostic and therapeutic intervention would you recommend to the patient?

2. A 15-year-old boy presents with severe pain in his scrotum.

·  Discuss how the history and physical exam might help you to differentiate between torsion and epididymitis.

Prevention

1. Discuss role of scrotal self-exam in early detection of testicular cancer.

2. Discuss methods for prevention/early detection of testicular cancer for patients with a previously undescended testicle.