Common testicular DOs Flashcards
Epididymitis: How does it happen?
Retrograde spread of urinary tract infection, STI, post-surgical constriction, or structural abnormality.
UTIs are rare. Urologic complaints, think of this.
Epididymitis: how common is it?
- Uncommon in prepubertal males
- Uncommon in non–sexually active males without a history of genitourinary tract abnormalities
- 31% of all cases of scrotal pain and swelling
Hx: what to expect with epididymitis
- gradual onset of pain localized in scrotum
- pain localized to epididymis, enlarged, tender and firm, hydrocele
PE: what to expect w/epididymitis
- febrile > 101 F
- testicle normal
- Prehn’s sign (elevation of testes on affected side decreases pain)
- Chlamydia and/or Gonorrhea, pyuria, bacteriuria
- Remember GC/CT not automatically on Urine Culture
MGMT for epididymitis
- STI treatment guidelines (2010) (e.g., PID)
- Ceftriaxone 250 mg IM PLUS
- Doxycyline 100mg BID x 10 days
If enteric organisms suspected (MSM insertive intercourse)
- Levofloxacin 500 mg BID OR
- Oflaxacin 300 mg BID x 10 days (E.coli & Pseudomonas)
- Motrin
- Close follow-up 48 hours
- Treat partners! Abstain until both adequately treated.
Testing if suspect epididymitis
- Find source of infection through urine culture and/or culture/NAAT of urethra
- US to r/o abnormality if UTI (possible structural abnormality)
DDx epididymitis
testicular torsion, tumor, abscess, infarction, testicular cancer, TB, & fungal epididymitis
What is a varicocele?
distention of multiple veins and the spermatic cord which are visible and palpable in varying degrees
Teen boys: volume is most important. 2 bead difference esp.
How and where to varicoceles happen?
- 90% occur on left side
- thought to be a result of incompetence of the spermatic vein, however many conflicting theories
How are varicoceles graded?
- Subclinical: not palpable or visible identified on Doppler (most)
- Grade I: palpable during Valsalva only
- Grade II: palpable at rest not visible
- Grade III: palpable and visible at rest (very unusual for teen boy)
Are varicoceles painful?
no
What lab results would you expect with varicocele?
- FSH increased
- LH normal unless severe bilaterally
- Testosterone ? Lower usually older men
- Don’t typically do blood tests
Testosterone: usually was abnormal to begin with
What is the treatment for varicocele?
surgical ligation or percutaneous testicular vein embolization if large
What is the most common solid tumor in males 15-35yo?
testicular
White vs Black - who is more likely to get a testicular tumor?
4(5):1 White:Black males
Risk factors for testicular tumor
Cryptorchidism
Personal or FMHx of testicular cancer
Characteristics of testicles / testicular tumor on PE
- Firm painless nodule that does not transilluminate (whereas fluid/hydrocele will)
- Scrotal edema affected side
- Enlargement of the testicle with/without change in consistency
History of testicular tumor
Painless, fullness or heavy sensation in the scrotum
acute pain if hemorrhage or necrosis
change in sex drive
associated sx of testicular tumor
Gynecomastia, change in sex drive, premature growth of body hair
Associated S/S if disseminated cancer (testicular tumor)
hemoptysis, bone pain, abdominal mass or supraclavicular mass
Types of testicular tumors
Seminomas
Nonseminomas
Diagnosis of testicular tumor/ca
Ultrasound
Blood work for tumor markers
MGMT of testicular tumor
- Surgery
- Management: Surgery, radiation, chemotherapy
Cure rate for testicular tumor/ca
Early detection = > 90% cure rate - thus TSE taught to all male adolescents
Describe the proper technique for performing a testicular self-exam to an adolescent patient and explain to the adolescent why it is important.
- best time is after a warm shower or while in the shower or bath when scrotum is relaxed.
- Gently roll each testicle between thumb and fingers of both hands. Hands should be warm. Normal testicle is egg-shaped and 4cm in length
- Testes may be different sizes, but have rubbery consistency and should be uniform. Left testicle usually lies slightly lower than the right
- Surfaces of your testes should be smooth with no lumps
- Check on top and slightly behind the testicle (the epididymis) → should be soft and slightly tender. Follow the epididymis up to check the spermaticcord → should be firm, smooth tubular structure
- If you feeel any lumps or hard areas, please let us know
- Teach them to come in as soon as they notice something!
What is cryptochordism?
Undescended testis that cannot be drawn into the scrotum
When does normal testicular descent occur?
8th month of gestation
If testicles not drawn into scrotum by ______ then unlikely to descend later
3-4 months of life
What is testicular torsion?
- Urologic emergency
- Pathophysiology: “bell clapper” deformity caused by the peritoneal investiture of the testis lying on the cord rather than on the lower pole of the testis
- causes ischemia and potential damage to the testis if not corrected
“infrastructure around testes not formed correctly” / Failure of the testis support structures
Presentation of testicular torsion
- nausea and vomiting
- lack of urologic symptoms
- 10% may be painless
- pain begins in the abdominal area and be referred to the iliac fossa or groin before localizing in the scrotum
- 1/3 may have history of similar episode (resolved on own – partial torsion)
- usually wake up with it
Most common age for Testicular Torsion
2/3 of cases occur between 12-18 years
Anatomic variations in testicular torsion
- Bell-clapper –horizontal instead of vertical- can turn easily
- Loose epididymal attachment to testis: defect btwn epid & testis itself
- Torsed testis w/transverse lie: turning above
Testicular torsion: what to expect on physical exam
- affected testis may be higher in the affected scrotum
- epididymis palpated in abnormal position – e.g., on medial side instead of lateral – hint may have turned
- Afebrile
- Cremastic reflex is absent (cremaster muscle does not pull up testis on effected side) – hit side of leg, won’t pull up like supposed to
- UA normal
Treatment of testicular torsion
- Surgical exploration and correction necessary!
- Doppler flow studies
- Manual derotation by urologist
Outcome for testicuar torsion
- 90% survival of testis
- delay of treatment by patient common
Explain testicular torsion to a teen.
this happens when the chord inside your scrotum which is holding your testis gets twisted. It causes reduced blood flow to your testes and can be very painful. It needs to be fixed immediately. It is common at birth and right at puberty. It can be fixed by surgery, where the untwist the cord and make sure it is not at risk for twisting again in the future.
Explain epididymitis to a teen.
This is an infection that started in your urinary tract and got deeper into your reproductive organs. It is most often caused by a UTI or an STI, and causes a fever, pain in your scrotum, and needs to be treated with antibiotics. Talk about safe sex..
