Testicles Flashcards
What are some important identifiers on examination and their differentials?
Cannot get above – inguinal hernia or proximally extending hydrocele
Separate and cystic – epididymal cyst
Separate and solid – epididymitis, varicocele
Testicular and cystic – hydrocele
Testicular and solid – tumour, haematocele, granuloma, orchitis – USS to differentiate
What are epididymal cysts and how do you manage them?
Usually develop in adulthood
Contain clear or milky fluid
Lie above and behind the testes
Remove if symptomatic
What is a hydrocoele?
Fluid within tuinca vaginalis
What is the difference between a primary and secondary hydrocoele?
Primary - associated with patent processus vaginalis (developmental outpouching of parietal peritoneum); more common, larger, most commonly occurs in younger men; can resolve spontaneously
Secondary - to a testis tumour, trauma, infection
How do you treat a hydrocoele?
Aspirate ± repetition of such
Corrective surgery if primary
Treat cause if secondary
What is a varicocele and how do you treat one?
Dilated veins of pampiniform plexus
Left side more commonly affected
Visible distended scrotal vessels - ‘bag of worms’
Dull ache
Surgical repair
What is a spermatocoele?
Build-up of fluid in the spermatic cord
What are epididymitis and orchitis and what causes them?
Inflammation of epdidymis or testis
STI/UTI ie Chlamydia, E.coli, N.gonorrhoea; TB
Trauma, urine in the epididymis
How do epididymitis and orchitis present?
Sudden onset tender swelling
Dysuria
Sweats, fever
How do you investigate epididymitis and orchitis?
1st catch urine sample
Urethral discharge? swab and culture
STI screen
How do you treat epididymitis and orchitis?
Doxycycline – Chlamydia
If gonorrhoea – add ceftriaxone
Use Abx for 2-4wks
Analgesia, drainage – if necessary
Treat partners too
What is testicular torsion?
Mechanical twisting of the spermatic cord → cuts off testicles blood supply/ischemia
What are some risk factors for testicular torsion?
Most common just after birth and during and after puberty (up to 30yrs)
Risk factors
- Larger testicle (due to normal variation or tumour)
- Congenital malformation called processus vaginalis (bell-clapper deformity)
i) Accounts for most cases
ii) Testicle is inadequately fixed to the scrotum and so is free floating - Trauma (rare), most occur spontaneously
How does testicular torsion present?
Severe, rapid onset testicular/groin pain and tenderness
N+V
Erythema and swelling of testicle
Testicle may be higher than normal
How do you investigate torsion?
Clinical examination
Doppler USS - may demonstrate lack of blood flow to testis
How do you treat torsion?
Surgical emergency
If surgery <6hrs = 90%+ salvage; >24hrs = <10%
Realignment of testis + fixation of both testes to scrotum to prevent recurrence (orchidopexy)
Potential need for orchidectomy
What is the epidemiology of testicular cancer?
Commonest malignancy in men aged 15-44
10% occur in undescended testes, even after orchidopexy (moving of undescended testicle to scrotum and fixing in place)
Other risk factors – infant hernia, infertility
What are the common cell lines involved?
Seminoma 55% (30-65yrs)
Non-seminomatous germ cell tumours – 33%
Mixed germ cell tumour – 12%
Lymphoma
Contralateral tumour found in 5%
How does testicular cancer present?
Painless testicle lump – typically found after trauma/infection
± haemospermia, secondary hydrocele
Pain
Dyspnoea (lung mets) Abdominal mass (enlarged nodes)
Effects of secreted hormones – i.e. excess androgens
What are metastases rates?
25% of seminomas and 50% of NSGCTs present with metastases
abdominal lymph nodes, lung, liver, bone, brain
How do you investigate testicular cancer?
Excision biopsy – diagnostic
CXR/CT/MRI – staging
α-FP and ß-hCG – are useful tumour markers and can be used for monitoring of treatment
How do you treat testicular cancer?
Radical orchidectomy
Seminomas are sensitive to radiotherapy
i) Seminoma – radio+orchidectomy = 95% curative
NSGCT ± mets
i) Bleomycin + etoposide + cisplatin
Self examination is necessary to reduce late presentation