Testicular troubles

Question 1

Epididymo-orchitis- cause, symptoms and management

Answer 1

Acute inflammation caused by bacterial infection. In men < 35 consider gonorrhoea or chlamydia. Amiodarone is another cause.
Unilateral swelling and pain, dysuria, discharge, rule out a torsion.
Management: Ceftriaxone IM then doxycycline for 10-14 days.

Question 2

Testicular torsion- symptoms and management

Answer 2

Twist of the spermatic cord leading to ischemia and necrosis. Common in ages 10-30. Severe sudden onset pain +/- nausea and vomiting.
Swollen upwardly retracted testes.
Cremasteric reflex is lost and elevation of testes doesn’t ease the pain.
Treatment is urgent surgical exploration.

Question 3

Testicular hydrocele

Answer 3

Trans illuminating mass, able to get above it. USS to exclude tumour.

Question 4

Testicular cancer- about

Answer 4

Commonest in ages 15-35.
95% from haploid/germ cells.
Commonly seminomas.

Question 5

Testicular cancer- risk factors

Answer 5

Caucasian, family history, infertility, Klinefelter syndrome, mumps orchitis, trauma.

Question 6

Testicular cancer- symptoms and tests

Answer 6

Non tender mass which doesn’t trans illuminate.
+/- hydrocele and gynaecomastia.
Do a testicular USS, LDH, AFP and bhCG levels.
CT for staging.

Question 7

Testicular cancer- treatment

Answer 7

Orchidectomy + sperm banking

RT if high risk disease.