Diseases of Scrotal Content PDF

Diseases of Scrotal Content: Varikosel Hydrocele Spermatocele Cevdet Kaya, MD Professor of Urology Medical School in Istinye University  Learning Outcomes  Able to describe anatomy of the scrotum and the organs of scrotal...

Diseases of Scrotal Content: Varikosel Hydrocele Spermatocele Cevdet Kaya, MD Professor of Urology Medical School in Istinye University  Learning Outcomes  Able to describe anatomy of the scrotum and the organs of scrotal content  Able to describe the definition of varicocele, hydrocele, spermatocele  Able to evaluate of a patient with varicocele  Able to define the normal values of semen analysis  Able to evaluate the treatment options of hydrocele and spermatocele  Varicocele 15% of the normal male population and 1 out of 3 of men with infertility Abnormal dilatation of the veins in plexus pampiniformis in spermatic cord Testicular temperature elevation and venous reflux Commonest etiology among male infertility Adolescent varicocele important issue for testicular growth  Varicocele  Semen parameters anomalies  Decreasing testicular volume  Decreasing leydig cell functions  Progressive disease  May cause hormonal anomaly  Pathogenesis may be oxidative damage  Evaluation  Medical and reproductive history  Physical examination with the patient in both the recumbent and upright positions  At least two semen analyses  A palpable varicocele feels like a “bag of worms”  Valsalva maneuver in a standing position  Only palpable varicoceles associated with infertility  Scrotal ultrasonography indicated for clarification of an inconclusive physical examination of the scrotum  Treatment Indications  Treatment of the varicocele should be considered when all of the following conditions are met 1) the varicocele is palpable on physical examination of the scrotum 2) the couple has known infertility 3) the female partner has normal fertility or a potentially treatable cause of infertility 4) the male partner has abnormal semen parameters or abnormal results from sperm function tests  Treatment Indications  Not indicated in patients with either normal semen quality or a subclinical varicocele  Adult men who have a palpable varicocele and abnormal semen analyses but are not currently attempting to conceive should also be offered varicocele repair  Adolescents who have a varicocele and reduced ipsilateral testicular size should be offered varicocele repair  Adolescents who have a varicocele but normal ipsilateral testicular size – follow up monitoring  Treatment Indications  Testicular dysfunction, and a deleterious effect on spermatogenesis – Scrotal temperature increase – Reduced blood flow and increased pressure caused by venous stasis and small vascular occlusion caused by hypoxia, sertoli and germinal cell dysfunction – decreased androgen secretion – Increase in catecholamines in spermatic vein – Reflux of renal and perirenal metabolites – Increased NO levels in spermatic vein and associated increased reactive oxygen metabolites – Reduction of apoptosis regulators  Grading  Subclinical: detected only by Scrotal doppler US but non- palpable and non-visible at rest or by valsalva manoeuvre  Grade 1: Palpable only during valsalva  Grade 2: Palpable even at rest, but invisible  Grade 3: Visible/palpable even at rest  Treatment  Varicocelectomy – Micrsocopic – Subinguinal  Treatment  Percutaneous embolization treatment  Hydrocele  Collection of liquid between the layers of tunica vaginalis because of either increased secretion or decreased absorption  Primary: Patent processus vaginalis – Mostly seen in newborns – Persistence in 20% of the adults  Secondary: Closed processus vaginalis  Hydrocele  Communicating hydrocele (mostly seen at pediatric age)  Congenital hydrocele: Associated with indirect hernia  Secondary hydrocele (adolescent-adult) – Infection (Epididimitis-orchitis) – Trauma – Linked to neoplasia, – Testicular torsion – Varicocele complication  Presentation  Scrotal pain or feeling of weight  Cosmetic causes  Cancer anxiety  Treatment is hydrocelectomy operation  Spermatocele or Epididymis Cyst  Asymptomatic benign cystic dilatation in epididimal tubules  Not cause obstruction  Rarely required surgery