Benign Testicular Disorders

Question 1

testicular torsion - overview

Answer 1

*turning of the testicle, which causes the spermatic cord to twist
*if the spermatic cord remains twisted, venous plexus drainage is interrupted & testicular artery is occluded, resulting in compromised blood supply to the testis
*most commonly diagnosed in males in the first few months of life or during puberty (age 12-18)

Question 2

testicular torsion - risk factors

Answer 2

1. bell-clapper deformity: abnormal congenital development of the tunica vaginalis
2. testicular atrophy
3. cryptorchidism: incomplete descent of the testis
4. absent / underdeveloped gubernaculum ligament

Question 3

testicular torsion - clinical presentation

Answer 3

*sudden, severe, unilateral scrotal pain
*may be associated with edema, nausea, vomiting
*physical exam findings:
-high riding testis
-lack of cremasteric reflex

Question 4

testicular torsion - diagnosis

Answer 4

*color Doppler ultrasonography showing testicular edema & reduced / absent blood flow, + engorgement of the torsed testes

Question 5

testicular torsion - treatment

Answer 5

*immediate urologic consultation:
1. manual detorsion & emergent scrotal exploration
2. surgical correction (orchiopexy)
*treatment goal = unwind the twisted spermatic cord & restore blood flow ASAP

Question 6

testicular hydrocele - overview

Answer 6

*an abnormal accumulation of fluid within the scrotum
*2 types: communicating (congenital) and noncommunicating (acquired)

Question 7

communicating testicular hydrocele - overview

Answer 7

*seen in neonates
*aka congenital testicular hydrocele
*a patent processus vaginalis allows for flow of peritoneal fluid into the scrotum

Question 8

noncommunicating testicular hydrocele - overview

Answer 8

*seen in adults
*aka acquired testicular hydrocele
*no communication between the peritoneal cavity and the scrotum (processus vaginalis closed properly during development)
*caused by either: production of fluid from a disease process or impaired fluid resorption from lymphatic or venous disruption in the scrotum (infection, trauma, tumor)

Question 9

testicular hydrocele - clinical presentation

Answer 9

*communicating: asymptomatic or painless scrotal mass in infants
*noncommunicating: painful or painless scrotal mass
*physical exam: soft fullness in the scrotum; transilluminates (because it contains clear serous fluid)

Question 10

testicular hydrocele - diagnosis

Answer 10

*scrotal ultrasonography

Question 11

testicular hydrocele - treatment

Answer 11

*communicating: usually self-resolves
*noncommunicating: observation or surgical removal

Question 12

testicular varicocele - overview

Answer 12

*an abnormal enlargement of the veins in the pampiniform plexus of the spermatic cord
*caused by insufficient venous drainage
*most often occur on the LEFT side

Question 13

testicular varicocele - clinical presentation

Answer 13

*asymptomatic; found incidentally on infertility workup
*symptomatic: scrotal enlargement or pain
*physical exam: “bag of worms” as a result of backed-up blood distending the venous plexus
*Valsalva maneuver increases size of varicocele & scrotum

Question 14

testicular varicocele - diagnosis

Answer 14

*color Doppler ultrasonography
*enlarged veins alongside the testis that dilate during the Valsalva maneuver
*does NOT transilluminate

Question 15

testicular varicocele - treatment

Answer 15

*surgical ligation or embolization, if associated with pain or infertility
*returns the venous flow and temperature regulation of the scrotum to normal

Question 16

cryptorchidism - overview

Answer 16

*incomplete descent of the testis from the abdominal cavity to the scrotum (usually unilateral)
*risk factors: prematurity, FHx of genital disorders, low birth weight, maternal smoking during pregnancy
*associated with increased risk of germ cell tumors

Question 17

cryptorchidism - clinical presentation

Answer 17

*asymptomatic
*scrotum is found to be empty on physical exam
*testis can be felt along inguinal canal

Question 18

cryptorchidism - diagnosis

Answer 18

*ultrasound or MRI to identify location of undescended testis

Question 19

cryptorchidism - treatment

Answer 19

*most resolve without treatment
*if unresolved, surgery before age 2 (orchiopexy or orchiectomy)