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.
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.
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.
 ○ 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.
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.