Develop in adulthood Contain clear or milky (spermatocele) fluid Lie above and behind testis Remove if symptomatic

Dilated veins of pampiniform plexus Presentation - Feel like bag of worms in the scrotum - May be visible dilated veins - ↓ size on lying down - Dull ache • Mx - Conservative: scrotal support - Surgical: clipping the testicular vein (open or lap)

- May resolve spontaneously • Surgery: - Lord’s Repair: fold the sac - Jaboulay’s Repair: eversion of the sac • Aspiration - Usually recur so not 1st line. - Send fluid for cytology and MC+S

Testicles Flashcards by Anmol Landa

Testicular Torsion

• Usually secondary to exertion or minor trauma
• tunica vaginalis invests whole of testicle
- therefore free-hanging testicle can twist on
its mesentery

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Presentation of testicular torsion

Sudden onset severe pain in one testis
May have lower abdominal pain (testis supplied by T10)
Associated with N/V
May be Hx of previous testicular pain or torsion

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Examination of testicular torsion

Inflammation of one testis: hot, swollen, extremely tender

* Testis rides high and lies transversely

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Mx of testicular torsion

Mx
• Surgical emergency
- 4-6h window from onset of pain to salvage testis
• Inform senior
• NBM
• IV access
- Analgesia
- Bloods: FBC, U+E, G+S, clotting

• Surgery

Consent for possible orchidectomy
Bilateral orchidopexy: suture testes to scrotum

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Epididymal Cyst

Develop in adulthood
Contain clear or milky (spermatocele) fluid
Lie above and behind testis
Remove if symptomatic

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Varicocele

Dilated veins of pampiniform plexus
Presentation
Feel like bag of worms in the scrotum
May be visible dilated veins
↓ size on lying down
Dull ache

• Mx
- Conservative: scrotal support
- Surgical: clipping the testicular vein (open or
lap)

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Pathology of varicocele

Pathology
Primary: Left side commoner: drain into left renal vein

Secondary: left renal tumour has tracked down renal vein → testicular vein obstruction.

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Hydrocele

• Collection of serous fluid within tunica vaginalis

• Primary- patent processus vaginalis
- Commoner, larger, tense, younger men

• Secondary

Tumour, trauma, infection
Smaller, less tense

• Ix
- USS testicle to exclude tumour

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Mx of hydrocele

May resolve spontaneously

• Surgery:

Lord’s Repair: fold the sac
Jaboulay’s Repair: eversion of the sac

• Aspiration

Usually recur so not 1st line.
Send fluid for cytology and MC+S

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Epididymo-Orchitis aetiology

Local extension of infection

STI: Chlamydia, gonorrhoea
Ascending UTI: E. coli
Mumps

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Presentation of epididymo-orchitis

Sudden onset unilateral tender swelling
Dysuria
Sweats, fever

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Examination of epididymo-orchitis

• Tender, red, warm, swollen testis and epididymis
- Elevating testicle may relieve pain - Prehn’s sign
• Secondary hydrocele
• Urethral discharge

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Investigations for epididymo-orchitis

Blood: FBC, CRP
first-void urine NAAT - STI
Urine: dip, MC+S (first void)
Urethral swab and STI screen
USS: exclude abscess

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Mx of epididymo-orchitis

Bed rest
Analgesia
Scrotal support

• Abx:
- Enteric organisms – Ofloxacin 14 days

STI organisms – Ceftriaxone IM single dose and Doxycycline PO 10 - 14 days

• Drain abscess if present

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Testicular tumours pathology

Germ Cell: 95% 
• Seminoma 40%
- ↑ βhCG 
- ↑ placental ALP 
- metastasise late

• Non-seminoma

Mixed - commonest NSGCT
Teratoma
Yolk Sac
Choriocarcinoma - ↑↑ βhCG

Sex-cord Stromal 5% (benign)
• Leydig Cell
- May secrete androgens or oestrogens

• Sertoli Cell

Mostly benign
May secrete oestrogens

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Teratoma

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Arise from all 3 germ layers
Common and benign in children
Rare and malignant in adults: 15-30yrs
Secrete βhCG and/or AFP
Chemosensitive

Ix for testicular tumours

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• Tumour markers - monitoring
• Scrotum USS - initial
• Staging
- CXR
- CT chest, abdomen, pelvis (CAP)
•  Biopsy not done due to seeding risk

Tumour markers

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↑AFP and ↑hCG in 90% of teratomas
↑hCG in 15% of seminomas
Normal AFP in pure seminomas
LDH - marker of tumour volume

Mx of testicular tumours

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• If both testes are abnormal, semen can be
cryopreserved

Seminomas
• Stage 1-2: inguinal orchidectomy + radiotherapy

• Stage 3-4: as above + chemo (BEP)

Non-seminomas:
• Stage 1: inguinal orchidectomy + surveillance
• Stage 2: orchidectomy + chemo + para-aortic LN
dissection
• Stage 3: orchidectomy + chemo