Miss Rashmi Singh

Consultant urological Surgeon

Men’s Health Seminar

Parkside Hospital November 2016

SCROTAL PENILE

Hernia

Hydrocele

Varicocele

Infections

Epididymal cyst

Testicular Ca

Miscellaneous

Phimosis Paraphimosis Balanitis Frenulum Infective lesions

Young males

Anxious

Media coverage

Often feel normal anatomy e.g. epididymis

Ask them to identify the “lump”

Reassurance

Benign

Cystic degenerative change

Palpable separate from and above testis

“3rd testis”

Contain clear fluid

Easily confirmed on USS

Post vasectomy - spermatocele

Only excise if symptomatic

Avoid surgery until completed family

Separate and above testis

Usually irreducible

Risk of strangulation

Refer general surgery

Dilatation of pampiniform venous plexus

“Bag of worms”

Examine in standing position

Aching classically at end of day

Long periods of standing

Found in 40% of infertile men

Can impair testicular growth and spermatogenesis

Pain

Impaired testicular growth in adolescents

Potentially correctable factor in infertile couple

Asymptomatic-no treatment

Usually treated with radiological embolisation

Collection of fluid within tunica vaginalis

Benign

Painless

Usually secondary

Paediatric-needs early repair

Testis lies within hydrocele

Testis often impalpable if large

Transilluminable

Excise only if symptoms/cosmesis

Aspiration not recommended

Infectious

Tender

Indurated, hard mass

Beware diabetic abscess

<35 chlamydia/gonorrhoea: doxycycline

>35 E.coli: ofloxacin

14/7 plus NSAID

Swelling make take 8-12 weeks to fully resolve

Aggressive necrotising fasciitis of perineum and genitalia

Rare. Can be fatal

Diabetics

Immunosuppressed

malnourished

Elderly males

Nursing home

Indwelling catheters

Recent instrumentation/ perineal surgery

Severe sepsis

Painful, swollen, erythematous skin

Bullae/necrotic skin

Crepitus

Offensive smell

Urgent debridement and parenteral antibiotics

Solid painless lump.

Palpable within in body of testis

Rarely ◦ Cough

◦ Headache

◦ Back pain

Family history

Undescended testis

USS gold standard

Refer any solid intra-testicular lump under 2 week rule

Staging CT

Tumour markers: AFP/BHCG/LDH

Sperm banking

Inguinal orchidectomy/prosthesis

95% cure rates. 80% mets

Highly radio/chemo sensitive

common in scrotal skin Smooth surface Fixed to skin

Post scrotal surgery Vasectomy

Hydrocele

Conservative management ◦ Scrotal support

◦ Analgesia

◦ May take weeks to resolve

High impact trauma

Risk of testicular rupture ◦ Urgent us/refer A&E if unable to palpate whole

testis

◦ Surgery to evacuate haematoma and debride/repair

Emergency

Tight foreskin cannot be pulled forward from retracted position

After intercourse/self-retraction

Constriction band

Engorgement/swelling of penis

Painful strangulation

Urgent reduction

Interval circumcision

•Benign

•Moist erythematous lesions

•Usually asymptomatic

•Well circumscribed

•Responds well to circumcision

Common skin conditions

Lichen sclerosis

White hyperkeratotic lesions

Phimosis, stricture

May be associated with future malignant change

May need biopsy if no response to topical steroids, circumcision

Phimosis

Recurrent Paraphimosis

Balanitis

BXO

Failed frenuloplasty

Lesions on foreskin of uncertain nature

Not for religious indications

Rare. Refer any suspicious lesion on 2 week pathway

Use USS when in doubt

Solid lumps in body of testis need urgent referral

Epididymo-orchitis- may take many weeks to settle

Penile cancer extremely rare

Refer any ulcers/suspicious lesions on glans early if no response to topical steroid

Miss Rashmi Singh

Consultant Urological Surgeon

info@ladyurologist.co.uk

www.ladyurologist.co.uk