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Thread: Scrotal Swelling-Viva Question

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    Default Scrotal Swelling-Viva Question

    Case 1. PRIMARY VARICOCOELE

    Q. What is your diagnosis ?
    A. Left primary varicocoele.


    Q. Why this is varicocoele ?

    A. Because there is an inguinoscrotal swelling
    characterized by ;
    * By inspection : Varicose veins are seen just
    beneath the skin of the scrotum (bag of worm
    appearance)
    * By palpation : There are multiple soft,
    compressible swellings with impulse and thrill on
    cough. They decrease in size on lying down and
    disappear on elevation of the scrotum.


    Q. What is the definition of varicocoele ?

    A. It is dilatation, elongation, and tortuosity of the
    pampiniform plexus of veins.


    Q. What are the types of varicocoele ?
    A. Primary and secondary varicocoele.

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    Q. How does hypernephroma produce
    secondary varicocoele ?

    A. By extension of tumour thrombus into the renal
    vein leading to obstruction of the testicular vein.


    Q. On which side is 2ry varicocoele more
    common and why ?

    A. On the left side, because the left testicular vein
    drains into the renal vein, while the right testicular
    vein drains into the inferior vena cava. So, 2ry
    varicocoele on the left side occurs when there is
    tumour thrombosis of the left renal vein, whereas
    on the right side, thrombosis should extend to the
    IVC to occlude the right testicular vein.


    Q. Why 1ry varicocoele is more common on
    the left side ?

    A. Because of the following reasons :
    1. 1. The left testicular vein is longer than the
    right one (left testis lies at a lower level than
    the right one)
    2. 2. The left testicular vein opens at right angle
    into the left renal vein and no protective
    valve at this site
    3. 3. The left testicular vein lies beneath the
    sigmoid colon and may be liable to
    compression
    4. 4. The left renal vein passes in the angle
    between the aorta and the superior
    mesenteric vein and this angle may be
    narrow and acts as a nutcracker causing
    compression of the vein.
    5. 5. The left common iliac vein is crossed by
    the right common iliac artery

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    Q. What are the complications of 1ry
    varicocoele ?

    A. 1. Recurrent attacks of thrombophlebitis.
    2. 2ry hydrocoele.
    3. Infertility (if there is serious depression of
    sperm count).
    4. Neurosis (pain).
    5. Testicular atrophy (from prolonged congestion).


    Q. What are the different lines of treatment
    of 1ry varicocoele ?

    A. 1. Conservative treatment for all cases.
    2. Operative treatment for some cases.


    Q. What are the indications for surgery in 1ry
    varicocoele ?

    A. 1. Serious depression of spermatic count
    (oligospermia).
    2. Big painful varicocoele.
    3. Employment and acceptance in military & police
    academies.


    Q. Do you know the different approaches for
    varicocoele ?

    A. Yes, there are 4 approaches :
    1. Scrotal 2. Inguinal
    3. Pelvic (Palomo op.) 4. Laparoscopic

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    Default VAGINAL HYDROCOELE-- Viva Questions

    Case 2. VAGINAL HYDROCOELE


    Q. What is your diagnosis ?
    A. Rt. primary vaginal hydrocoele.


    Q. What are the types of hydrocoele ?
    A. 1. Congenital hydrocoele 2. Infantile hydrocoele
    3. Vaginal hydrocoele 4. Encysted hydrocoele of
    the cord
    5. Hydrocoele of the canal of Nuck 6. Hydrocoele
    of hernial sac
    N.B. The so called diffuse hydrocoele of the cord is
    one of the forms of chronic filarial funiculitis. It is
    not a true hydrocoele but it is just a lymphoedema
    of the cord making it soft gelatinous in consistency.

    Q. What is vaginal hydrocoele ?

    A. It is accumulation of serous fluid between the
    two layers of the tunica vaginalis.


    Q. What are its types ?
    A. It is of two types :
    1. 1ry vaginal hydrocoele : of unknown
    aetiology
    2. 2ry vaginal hydrocoele : 2ry to any disease
    of the testis, epidedymis or spermatic cord.


    Q. How did you know that it is purely scrotal ?

    A. By grasping the neck of the scrotum by two
    fingers; the thumb infront and the index finger
    behind the neck, it was found that the swelling is
    completely below the fingers.

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    Q. How did you know that it is a cystic
    swelling ?

    A. By doing the bipolar fluctuation test ; One
    hand's fingers are placed around the neck of the
    scrotum, and the other hand's fingers hold the
    bottom of the swelling. The latter squeezes the
    swelling where an impulse is perceived by the
    other hand's fingers at the top of the swelling.


    Q. What are the values of transillumination in
    hydrocoele ?

    A. It differentiates between hydrocoele which is
    translucent and other opaque cysts. It also
    localizes the testis in case of vaginal hydrocoele.


    Q. What is the value of localizing the site of
    the testis in hydrocoele ?

    A. To avoid its injury if aspiration is done. The
    shape and size of the testis also could be assessed


    Q. How can you detect secondary vaginal
    hydrocoele ?

    A. By pinching the tunica vaginalis.


    Q. What are the other intrascrotal cysts you
    know ?

    A. Spermatocoele, Pyocoele, Acute heamatocoele,
    Encysted hydrocoele of the cord, Cystic teratoma,
    Breaking down gumma, Cysts of embryonic
    remnants of the epidedymis.


    Q. What is spermatocoele?
    A. It is a retention cyst situated in the head of the
    epidedymis due to obstruction of the vasa
    efferentia.

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    Q. What do you mean by transillumination is
    opalescent in spermatocoele ?

    A. This word means that the cyst is a midway
    between translucent and opaque.


    Q. How can you explain this type of
    transillumination in spermatocoele ?

    A. It is due to its content of sperms.


    Q. What are the complications of hydrocoele ?
    A. complications of hydrocoele include :
    1. 1. Rupture by severe trauma
    2. 2. Haematocoele (spontaneous, trauma,
    aspiration)
    3. 3. Infection (----> pyocoele)
    4. 4. Calcification of the sac
    5. 5. Atrophy of the testis (in long standing
    cases)
    6. 6. Hernia of the hydrocoele (in long standing
    cases, through dartos muscle as a result of
    high tension)


    Q. What are the lines of treatment of 1ry
    vaginal hydrocoele ?

    A. 1. Operation : The ideal treatment
    2. Aspiration : In unfit patients


    Q. What are the operations you know for 1ry
    vaginal hydrocoele ?

    A. 1. Excision of the tunica (if very large,
    thickened or calcified)
    2. Evertion of the tunica (if not large, thickened or
    calcified)
    3. Lord's operation (if not large, thickened or
    calcified)


    Q. What are the complications of aspiration ?
    A. 1. Recurrence (100%).
    2. Infection.
    3. Haemorrhage.
    4. Puncture of the testis.

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