testicular disease by Ax2YAZF

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									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
  –   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
           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
  – Hard, irregular, non-tender mass
  – Partial or whole testis


• Investigations
  – Bloods: AFP, HCG (repeat post-op)
  – Scrotal U/S
  – Staging: CXR, CT Abdo/Pelvis
         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
                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

								
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