Examination of the scrotum

Abstract

Checklist WIPER • Patient standing. Trousers removed. Exposure from nipple to knee. Chaperone as required. Physiological parameters Inspection • Scrotal asymmetry: pathology within hemiscrotum: • absent testicle: failure of scrotal development or testicular descent, or orchidectomy • scrotal mass • Skin: • oedema, cellulitis, Fournier's gangrene • scars from previous scrotal surgery or orchidopexy • Groin: scars (hernia repair) and masses (undescended testis) Palpation Patient standing: Ask: ‘Do you have any pain?’ • Anatomy: define (a) superficial inguinal ring, (b) spermatic cord and vas deferens, (c) testicle, (d) epididymis. Compare left and right sides. • Scrotal skin lumps: sebaceous cysts, abscesses and furuncles. • Testicle: presence, contour, masses, size. If absent testicle, palpate groin and see if able to manipulate testicle into scrotum. • Epididymis (posterior aspect of testis): tender or swollen. • If scrotal mass felt: • Can you get above it? • Can you define testis and epididymis separately? • Does the mass transilluminate (hydrocoele)? • Is there a cough impulse (hernia/varicocoele)? Patient supine: • Re-examine the scrotum. Assess if any palpable abnormality becomes less prominent, as in the case of a varicocoele or hernia. Always ensure the scrotum is lifted up to inspect the posterior aspect of the scrotum and perineum. To complete the examination … • Examine the abdomen, especially if the testicle feels abnormal. • Examine groin, penis and perineum: identify hernias, undescended or ectopic testes. Examination notes What are the essential history points for a scrotal mass? History as for any mass (see Chapter 39, Examination of skin lesions and lumps ). Specific points to elucidate: • Previous scrotal operations • Risk factors for testicular malignancy (undescended testis, family history, infertility, small testis) What do you look for on inspection of the scrotum? • Assess scrotal symmetry and development. Scrotal asymmetry together with the history may indicate the underlying pathology: e.g. a patient with a recent history of an inguinal hernia repair who has a smaller testicle on the same side would suggest testicular atrophy following hernia repair (ischaemic orchitis).