8/14/2019 Testicular Swelling for Medical Finals (based on Newcastle university learning outcomes)

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Hospital Based Practice Testicular swelling.

Anatomy

Average testicle measures 4 x 3 x 2.5 cm.

Each spermatic cord contains.

Vas deferens

Internal spermatic artery

External spermatic artery

Artery to the vas

Venous pampiniform plexus

Lymph vessels

Nerves

History.

Presentations can be emergency or non emergency.

Severe pain can be due to.

Trauma

Infection

Torsion of the cord

Felt locally

May radiate along cord to lower abdomen.

Dull ache suggests

Varicocele.

Early indirect inguinal hernia

Things that tend to cause painless swellings include.

Uninfected hydrocele

Spermatocele

Testis tumour

Pain also can be referred from other sites.

8/14/2019 Testicular Swelling for Medical Finals (based on Newcastle university learning outcomes)

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Infection.

Can be occur in epidiymis or testis.

Acute epididymitis.

Often due to. N. Gonorhoeae

Chlamydia trachomatis

E. coli

Infection normally ascends from urethra and bladder.

Associated with UTI symptoms.

Complications include.

Abscess

Atrophy

Infertility.

Chronic painless induration suggests.

TB Schistosomiasis

Non specific chronic epididymitis.

Torsion.

Can be of.

Spermatic cord

Testicular appendages.

Need to distinguish from infection.

Emergency surgery is needed.

Surgery should be performed within 6 hours.

Clinical picture. Peak age of incidence 13 15 years.

Severe pain

Sudden onset

Similar episodes in the past, with spontaneous resolution

May have history of mild trauma.

May present with lower abdominal pain

On examination, testis may be

High riding or horizontal.

Very tender

Investigations.

Doppler scan Radioisotope scan.

When surgery is performed, teather both testis.

8/14/2019 Testicular Swelling for Medical Finals (based on Newcastle university learning outcomes)

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Tumour

Epidemiology.

Most commonly affected age groups are. 20 45 Germ cell tumours

60+ Lymphoma

Risk factors include.

Being white

Cryptorchidism

Family history

Bilateral cancer occurs in 1 2% of cases.

Presentation.

Painless or slightly aching lump.

20% present with testicular pain.

10% present with weight loss and chest symptoms from metasteses. 10% are associated with a secondary hydrocele.

All patients presenting with hydrocele require investigation for cancer.

Clasification.

Germ cell 90%

Seminomas 42%

Non seminomas 48%

Teratoma

Yolk sac tumours

Choriocarcinoma

Mixed non semiomas

Mixed Germ cell 10%

Other tumours 7%

Epidermoid cyst

Adenomatoid tumour

Adenocasrcinoma of the rete testis

Carcinoid

Lymphoma

Metasteses.

Prostate

Lung

Colon

Kidney

Sex cell stromal tumours. 3%

Leydig cells

Sertoli cells

Mixed or unclassified

Investigations.

Ultrasound

Serum tumour markers

Staging CT.

Abdomen

Chest

Treatment.

8/14/2019 Testicular Swelling for Medical Finals (based on Newcastle university learning outcomes)

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Final investigation and definitive treatment is radical orchidectomy.

Curative treatment possible in about 80% of patients.

Further management normally happens under the oncologists.

Varicocele Dilation of veins of.

Pampiniform plexus.

Spermatic cord.

More common on left side than right.

Causes dull ache and bag of worms swelling.

Enlarged by

Heavy exercise.

Standing.

Examination.

Lying and standing.

Valsalva manoeuvre/ cough.

Investigations.

Ultrasound.

Scrotum

Abdomen

Seminal analysis.

Main complication is infertility.

Intervention.

Not always required.

Embolisation

Laproscopic or open surgery.

Hydrocele.

Abnormal collection of fluid between parietal and visceral layers of tunica vaginalis.

Primary.

Slowly developing

Secondary.

Infection

Trauma

Tumour

Usually painless.

Unless underlying testicular disease is painful.

Examination.

Testis is difficult or impossible to palpate.

Unless hydrocele is very lax

This degree of laxity is very rare.

Usually cystic.

Sometimes so tense that it feels solid.

Possible to transilluminate

Investigations.

US to check underlying testis.

Treatment.

Aspiration

Surgery.

8/14/2019 Testicular Swelling for Medical Finals (based on Newcastle university learning outcomes)

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Spermatic cyst.

Can be single or multiple.

Usually can be palpated separately to testis.

Usually mobile

Able to be transilluminated.

Often recurrent after surgical removal.

Very often recurrent after aspiration.

Other causes of swelling

Sebaceous cysts of scrotal skin.

Carcinoma of scrotal skin.