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 Exam 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 You may be able to see the hydatid of Morgagni as the “blue dot” through the scrotal skin. Mx by excision Epididymitis may have associated systemic symptoms

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 Investigations Hard, irregular, non-tender mass Partial or whole testis Investigations Bloods: AFP, HCG (repeat post-op) Scrotal U/S Staging: CXR, CT Abdo/Pelvis Half life AFP is 5-7 days, so persistent elevation at 2 weeks is suspicious for metastatic disease CT as may spread to para-aortic LN

Testicular disease Management Prognosis 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