1. Scrotal Lumps Kieran Jefferson UHCW

2. Current practice 4% of TWW referrals for suspected testicular cancer found to be malignant in recent audit Most commonly epididymal cysts/swellings

4. Anatomy

5. Anatomy (2)‏

6. History Age Symptoms – pain, dysuria, fever, duration Painful scrotal swelling in a young male is a torsion until proven otherwise

7. Examination

9. Can you get above the lump? Can you feel the lump separate to the testis? Is it cystic (transilluminate)?

10. Diagnoses Cannot get above the lump Inguinoscrotal hernia Varicocoele Hydrocoele of the cord Saphena varix

11. Diagnoses (2)‏ –Separate + Cystic = epididymal cyst –Separate + Solid = epididymitis –Testicular + Cystic = hydrocoele –Testicular + Solid = tumour

12. Hydrocoele

13. Hydrocoele treatment Aspiration – ineffective Surgical plication or excision of sac

14. Epididymal cyst

15. Varicocoele

16. Varicocoele treatment High ligation (Palomo)‏ Inguinal ligation Embolisation

17. Suspected tumour Two-week wait referral Inguinal orchidectomy Staging & oncology referral

18. Summary If it's not in the testis it's not a tumour If in doubt, refer as TWW