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    Assessment of A Testicular Mass: Dr. Saifulla Syed

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    samer falcon
    This document provides information on assessing testicular masses, including: 1) It outlines the important steps in history taking and physical examination when evaluating a testicular mass, such as determining onset and characteristics of the mass, performing a scrotal examination, and assessing for tenderness and sensations. 2) It reviews the main differential diagnoses for testicular masses, including conditions like hydrocele, hematocele, epididymal cyst, spermatocele, epididymo-orchitis, testicular torsion, and testicular malignancy. 3) It provides brief descriptions and typical presentations of each condition, as well as recommended management approaches.

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    Assessment of A Testicular Mass: Dr. Saifulla Syed

    Uploaded by

    samer falcon
    29 views16 pages
    This document provides information on assessing testicular masses, including: 1) It outlines the important steps in history taking and physical examination when evaluating a testicular mass, such as determining onset and characteristics of the mass, performing a scrotal examination, and assessing for tenderness and sensations. 2) It reviews the main differential diagnoses for testicular masses, including conditions like hydrocele, hematocele, epididymal cyst, spermatocele, epididymo-orchitis, testicular torsion, and testicular malignancy. 3) It provides brief descriptions and typical presentations of each condition, as well as recommended management approaches.

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    This document provides information on assessing testicular masses, including: 1) It outlines the important steps in history taking and physical examination when evaluating a testicular mass, such as determining onset and characteristics of the mass, performing a scrotal examination, and assessing for tenderness and sensations. 2) It reviews the main differential diagnoses for testicular masses, including conditions like hydrocele, hematocele, epididymal cyst, spermatocele, epididymo-orchitis, testicular torsion, and testicular malignancy. 3) It provides brief descriptions and typical presentations of each condition, as well as recommended management approaches.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    29 views16 pages

    Assessment of A Testicular Mass: Dr. Saifulla Syed

    Uploaded by

    samer falcon
    This document provides information on assessing testicular masses, including: 1) It outlines the important steps in history taking and physical examination when evaluating a testicular mass, such as determining onset and characteristics of the mass, performing a scrotal examination, and assessing for tenderness and sensations. 2) It reviews the main differential diagnoses for testicular masses, including conditions like hydrocele, hematocele, epididymal cyst, spermatocele, epididymo-orchitis, testicular torsion, and testicular malignancy. 3) It provides brief descriptions and typical presentations of each condition, as well as recommended management approaches.

    Copyright:

    © All Rights Reserved
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    of 16

    Assessment of a Testicular Mass

    Dr. Saifulla Syed


    Introduction

    • Scrotal swellings – common presentation in clinical practice


    • Varied etiology
    • Must not miss conditions – Testicular torsion, acute epididymo-
    orchitis and testicular malignancy
    History

    • Age
    • Onset and duration
    • Painful / painless
    • Predisposing factors
    • Urinary symptoms
    • Systemic symptoms
    • Masses anywhere else
    Examination

    • Scrotal skin
    • To get above the swelling – differentiate scrotal from inguino-
    scrotal swelling
    • Testis/epididymis/cord
    • Is the testis palpable separate from the swelling
    • Tenderness
    • Fluctuation
    • Transillumination
    • Testicular sensation
    • Any other masses – ab / supraclavicular
    Differential Diagnosis

    • Hydrocele
    • Hematocele
    • Pyocele
    • Epididymal cyst
    • Spermatocele
    • Epididymo-orchitis
    • Testicular torsion
    • Testicular malignancy
    • Varicocele
    Investigations

    • Baseline bloods ± Tumor markers (AFP, ß HCG, LHD)


    • Urinalysis
    • Scrotal U/S
    • Chest x-ray
    • CT scan
    Hydrocele

    • Age gp – middle age and later life, gradual onset, long duration
    • Clinical features –
    • Loss of rugosity, otherwise normal scrotal skin
    • Tense swelling – discomfort/pain
    • Fluctuation +
    • Transillumination +
    • Cannot feel testis apart from the swelling
    • Testicular sensation +
    • Management
    • Surgical – Excision and eversion of the sac
    Lord’s plication
    • Tapping
    Hematocele

    • Age gp – middle age, sudden onset, short duration


    • Clinical features –
    • Loss of rugosity ±
    • Painful swelling
    • Fluctuation ±
    • Transillumination –
    • Cannot feel testis apart from the swelling
    • Testicular sensation +
    • Management
    • Surgical – Evacuation of hematocele/hematoma
    Pyocele

    • Age gp, sudden onset, short duration, systemic symptoms ±


    • Clinical features –
    • Loss of rugosity ±, erythematous and odematous scrotal skin
    • Painful swelling
    • Fluctuation +
    • Transillumination –
    • Cannot feel testis apart from the swelling
    • Testicular sensation +
    • Management
    • Surgical – Drainage
    Epididymal Cyst

    • Age gp – middle age, gradual onset, long duration


    • Clinical features –
    • Loss of rugosity, otherwise normal appearing scrotal skin
    • Tense swelling – discomfort/pain
    • Fluctuation +
    • Transillumination ++
    • Can feel testis apart from the swelling
    • Testicular sensation +
    • Management
    • Surgical – Excision
    Spermatocele

    • Age gp – middle age, gradual onset, long duration


    • Clinical features –
    • Loss of rugosity, otherwise normal appearing scrotal skin
    • Tense swelling – discomfort/pain
    • Fluctuation +
    • Transillumination – poor
    • Can feel testis apart from the swelling
    • Testicular sensation +
    • Management
    • Surgical – Excision
    Epididymo-orchitis

    • Age gp – young men, middle and elderly, sudden onset, short


    duration, urinary/systemic symptoms
    • Clinical features –
    • Erythematous scrotal skin with normal rugosity
    • Painful swelling
    • Fluctuation –
    • Transillumination –
    • Tender swollen epididymis ± testis
    • Testicular sensation +
    • Elevation of testicle releaves pain
    • Management
    • Conservative – Anti-inflammatory/analgesics, antibiotics, scrotal
    elevation
    Testicular Torsion

    • Age gp – 10 to 25 yrs, acute onset, short duration


    • Clinical features –
    • Normal appearing scrotal skin
    • Acutely painful scrotal swelling; ab pain (misleading presentation)
    • Fluctuation and Transillumination –
    • Tender swollen high lying testis, difficult to differentiate cord
    structures
    • Testicular sensation +
    • Elevation of testicle worsens pain
    • Management
    • Urgent exploration, untwist the torsion and bilateral orchidopexy (±
    orchidectomy if the testis is non viable)
    Testicular Malignancy

    • Age gp – 20 to 45 yrs, gradual onset, long duration


    • Clinical features –
    • Normal appearing scrotal skin
    • Painless swelling
    • Fluctuation –
    • Transillumination –
    • Firm/hard irregular enlarged testis
    • Testicular sensation –
    • Ab mass ± neck mass
    • Management
    • High orchidectomy, CT/RT, RPLND
    Varicocele

    • Age gp – adolesence or early adulthood, gradual onset, long duration


    • Clinical features –
    • Normal appearing scrotal skin
    • Swelling +, discomfort/pain
    • Fluctuation –
    • Transillumination –
    • Can feel testis apart from the swelling
    • Testicular sensation +
    • “Bag of worms” feel
    • Management
    • Ligation of testicular vein (inguinal canal / retroperitoneal)
    Thank you

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