Testicular disease

19th May 2011

Jonathan Chua

Undescended testes

• More common in premature babies

• Spontaneous descent ~ 3 months (most)

• ~99% descended at the end of first year

• ~1% will need surgical correction

Undescended testes

• Differentials– Retractile testes– Absent testes– Ectopic testes

Undescended testes

• Management– Wait– Orchidopexy

• Preserve fertility• Reduce risk of torsion• Reduce risk of malignant change (but intrinsically

higher risk)

Testicular torsion

• History– Sudden onset scrotal pain– May radiate to lower abdo– May have preceding short-duration scrotal pain– Associated nausea & vomiting

• Exam– Testis may appear normal– Exclude other causes– One may lie higher than the other due to cord

shortening

Testicular torsion

• Differentials– Torsion of the testicular appendage– Acute epididymitis

Testicular torsion

• Investigations– Doppler

• Exploration required for suspected torsion– Preserve testis if potentially viable– Contralateral testis should also be fixed due

to risk of torsion

Testicular cancer

• Germ cell vs Stromal tumors

• Germ cell tumors more common

• More common in patients with abnormal testicular descent

Testicular cancer

• Hx– Painless swelling– Vague testicular discomfort– Symptoms of metastatic disease– Hx of abnormal testicular descent

Testicular cancer

• Exam– Hard, irregular, non-tender mass– Partial or whole testis

• Investigations– Bloods: AFP, HCG (repeat post-op)– Scrotal U/S– Staging: CXR, CT Abdo/Pelvis

Testicular disease

• Management– Orchidectomy– Depends on type of tumor

• Seminoma is highly radiosensitive• Non-seminoma germ cell tumors are highly

chemosensitive

• Prognosis– Overall >90% cure rate– Node-negative disease ~100% 5-year survival

To sum up

• Undescended testes– Management usually after 12 months of age– Orchidopexy to preserve fertility and ? reduce

risk of malignancy– Overall higher risk of testicular malignancy

To sum up

• Think about testicular torsion in males with lower abdo/scrotal pain

• Surgical exploration is required if testicular torsion is suspected

• Testicular tumors aren’t the worst cancer– Suspect it in a patient with a new hard irregular lump– Orchidectomy– Further Mx depends on type of tumor– Overall good prognosis