testicular disease 19 th may 2011 jonathan chua
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Testicular disease
19th May 2011
Jonathan Chua
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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
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Undescended testes
• Differentials– Retractile testes– Absent testes– Ectopic testes
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Undescended testes
• Management– Wait– Orchidopexy
• Preserve fertility• Reduce risk of torsion• Reduce risk of malignant change (but intrinsically
higher risk)
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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
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Testicular torsion
• Differentials– Torsion of the testicular appendage– Acute epididymitis
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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
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Testicular cancer
• Germ cell vs Stromal tumors
• Germ cell tumors more common
• More common in patients with abnormal testicular descent
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Testicular cancer
• Hx– Painless swelling– Vague testicular discomfort– Symptoms of metastatic disease– Hx of abnormal testicular descent
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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
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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
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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
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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