Page 1348 - TNFlipTest

U30 Urology
Scrotal Masses
Toronto Notes 2019
Penile Tumours
Epidemiology
• rare(<1%ofcancerinmalesinU.S.) • mostcommonin6thdecade
Benign
• cyst, hemangioma, nevus, papilloma
Pre-Malignant
• balanitisxeroticaobliterans,leukoplakia,Buschke-Lowensteintumour(largecondyloma)
Pre-invasive Cancer
• carcinomainsitu
■ Bowen’s disease → crusted, red plaques on the shaft
■ erythroplasia of Queyrat → velvet red, ulcerated plaques on the glans
■ treatment options: local excision, laser, radiation, topical 5-fluorouracil
Malignant
• riskfactors
■ chronic inflammatory disease ■ STI
■ phimosis
■ uncircumcised penis
• 2%ofallurogenitalcancers
• SCC(>95%),basalcell,melanoma,Paget’sdiseaseofthepenis(extremelyrare)
• definitivediagnosisrequiresfullthicknessbiopsyoflesion
• lymphaticspread(superficial/deepinguinalnodes→iliacnodes)>>hematogenous
Treatment
• widesurgicalexcisionwithtumour-freemargins(dependentonextentandareaofpenileinvolvement) ± lymphadenectomy
• considerlessaggressivetreatmentmodalitiesinCIS(cryotherapy,lasertherapy,etc.)ifavailable
Scrotal Masses
Table 22. Differentiating between Scrotal Masses
Varicocele Grading
• Grade1:PalpableonlywithValsalva manoeuvre
• Grade2:PalpablewithoutValsalva • Grade3:Visiblethroughscrotalskin
Condition
Torsion
Epididymitis Orchitis Hematocele Hydrocele
Spermatocele Varicocele Indirect Inguinal
Tumour
Generalized/ Dependent edema
Idiopathic
Pain
+
+ + + –
– –
– (+ if strangulated)
– (+ if hemorrhagic)
– –
Palpation
Diffuse tenderness Horizontal lie of testicle
Epididymal tenderness
Diffuse tenderness
Diffuse tenderness
Testis not separable from hydrocele, cord palpable
Testis separable from spermatocele, cord palpable
Bag of worms
Testis separable from hernia, cord not palpable, cough impulse may transmit, may be reducible
Hard lump/nodule Diffuse swelling
Additional Findings
Absent cremaster reflex, negative Prehn’s sign
Present cremaster reflex, positive Prehn’s sign Present cremaster reflex, positive Prehn’s sign No transillumination
Transillumination, Hx of trauma
Transillumination
No transillumination, increases in size with valsalva, decrease in size if supine
No transillumination
Often post-operative or immobilized, check for liver dysfunction
Suspect a Retroperitoneal Mass/Process in a Patient with a Varicocele if
• Acute onset
• Right sided (isolated)
• Palpable abdominal mass
• Does not reduce while supine
Indications for Treatment of Varicocele
• Impaired sperm quality or quantity
• Pain or dull ache affecting QOL
• Affected testis fails to grow in adolescents
• Cosmetic indications (especially in
adolescents)