1. Testicular disease
19th May 2011
Jonathan Chua

3. 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

4. Undescended testes Differentials Retractile testes Absent testes
Ectopic testes

5. Undescended testes Management Wait Orchidopexy Preserve fertility
Reduce risk of torsion
Reduce risk of malignant change (but intrinsically higher risk)

6. 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

7. 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

8. 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

10. Testicular cancer Germ cell vs Stromal tumors
Germ cell tumors more common
More common in patients with abnormal testicular descent

11. Testicular cancer Hx Painless swelling Vague testicular discomfort
Symptoms of metastatic disease
Hx of abnormal testicular descent

12. 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

13. 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

14. 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

15. 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