[Uro/Renal] Testicular Pain

Question 1

what can you triage causes of testicular pain and swelling into?

Answer 1

• emergency
• acute
• urgent
• non-urgent

Question 2

what are the emergency causes of testicular pain and swelling?

Answer 2

• torsion

- strangulated hernia

Question 3

what are the acute causes of testicular pain and swelling?

Answer 3

• epididymo-orchitis

- traumatic haematocele

Question 4

what are the urgent causes of testicular pain and swelling?

Answer 4

• testicular lump / cancer
• haematocoele
• painful varicocele

Question 5

what are the non-urgent causes of testicular pain and swelling?

Answer 5

• epididymal cyst / spermatocoele
• varicocoele / hydrocoele
• soft hernia

Question 6

how are emergency causes of testicular pain and swelling managed?

Answer 6

surgery (category 1)

Question 7

how are acute causes of testicular pain and swelling managed?

Answer 7

epididymo-orchitis → abx +/- admission

traumatic haematocele → admission for observation +/- drainage

Question 8

how are urgent causes of testicular pain and swelling managed?

Answer 8

2 week referral to urology with scrotal USS

Question 9

how are non-urgent causes of testicular pain and swelling managed?

Answer 9

discharge, or urology/surgery outpatient referral

Question 10

what is a urological emergency that requires urgent surgical intervention (<1 hour)?

Answer 10

testicular torsion

Question 11

what is the ischaemic time for a testis?

Answer 11

4-8 hours

Question 12

what does scrotal exploration allow for?

Answer 12

assessment of viability and a final decision on removal (orchidectomy) or fixation (orchidopexy)

Question 13

what is the implication of having one torted testis and what is done for it?

Answer 13

increases the chance of the other testis becoming torted → both are fixed in place (bilateral orchidopexy)

Question 14

what are the 3 peaks that exist for testicular cancer?

Answer 14

• infancy to age 4 (teratomas)
• 20-40 (non-seminoma and seminomas)
• > 60 (seminomas)

Question 15

what are the red flags and risk factors for developing testicular cancer?

Answer 15

• painless lump
• PMHx of mumps or cypto-orchidism
• FHx of testicular cancer

Question 16

what is the prognosis for testicular cancer?

Answer 16

95% if found early

Question 17

95% of testicular tumours are…?

Answer 17

germ-cell, including seminomas and non-seminomas

Question 18

what is the primary lymph node spread for testicular tumours?

Answer 18

para-aortic and retroperitoneal

Question 19

what is the 1st line ix for testicular cancer?

Answer 19

scrotal USS

Question 20

how is testicular cancer managed?

Answer 20

orchidectomy with histology +/- staging CT

Question 21

what is done if CT indicates lymph node involvement in testicular cancer?

Answer 21

lymph node dissection

Question 22

what is required in almost all cases of testicular cancer?

Answer 22

adjuvant chemotherapy

Question 23

how are pts with testicular cancer followed up?

Answer 23

up to 5 years with tumour markers, CXR and abdominal US/CT

Question 24

painless lump in a male >60 years. dx?

Answer 24

benign seminoma

Question 25

painless lump in a young male, B-hCG +ve. dx?

Answer 25

non-seminoma

Question 26

prolonged pain + swollen testicle, hx >1 day. dx?

Answer 26

epididymo-orchitis (STI vs E.coli)